冠脉搭桥围术期胃粘膜二氧化碳分压和术后器官功能评分的变化

Changes of perioperative gastric intramucosal PCO_2 and postoperative sequential organ failure assessment score in patients undergoing coronary artery bypass grafting

目的 观察不同时间的心肺转流 (CPB)下 ,冠脉搭桥术中和术后胃粘膜二氧化碳分压(PgCO2 )及ICU期间器官功能评分的变化。方法 2 0例择期冠脉搭桥手术患者 ,根据CPB时间分为短于 10 0min组 (A组 ,n =10 )和超过 10 0min组 (B组 ,n =10 )。麻醉诱导气管插管后插入胃张力计导管 ,术中及术后监测PgCO2 ,分别统计术中和ICU期间PgCO2 最高值以及PgCO2 >5 0mmHg的累积时间。入ICU后根据序贯器官衰竭评分系统 (SOFA)对器官功能进行评分 ,以后每 2 4小时进行一次。计算并记录ICU第 1天SOFA、ICU期间总的最高SOFA评分 (TMS)以及ICU停留时间。结果 (1)两组术中PgCO2 最高值差异无显著意义 ;但B组PgCO2 >5 0mmHg的累积时间明显长于A组 (P <0 0 5 )。 (2 )两组ICU期间 ,PgCO2 最高值和PgCO2 >5 0mmHg的累积时间差异有显著意义 (P <0 0 5或P <0 0 1)。 (3)ICU第 1天SOFA评分、TMS和ICU停留时间在两组差异有显著意义 (P <0 0 5 )。结论 冠脉搭桥中CPB时间较长者 ,术中及术后出现胃粘膜酸中毒的程度较重、时间较长 ,反映器官功能障碍的SOFA评分较高 ,预后差。

Objective To investigate the changes of perioperative gastric intramucosal CO 2 pressure(PgCO 2)and postoperative sequential organ failure assessment(SOFA)score in patients undergoing coronary artery bypass grafting(CABG)under cardiopulmonary bypass(CPB).Methods Twenty patients were divided into group A(CPB less than 100 min,.n=.10)and group B(CPB more than 100 min,.n=.10).After induction of anesthesia and endotracheal intubation,the patients were fitted with a gastric tube which connects to gastric tonometer(Tonocap)and gastric intramucosal CO 2 pressure(PgCO 2)was measured.The maximum value of PgCO 2 and the cumulative time of PgCO 2 beyond 50 mmHg were recorded during operation and the intensive care unit(ICU)stay.Postoperative morbidity assessed by SOFA score on the first day in ICU,and the total maximum SOFA score(TMS).Time staying at ICU also was recorded as an index reflecting postoperative morbidity.Results There was no difference between group A and B on the peak PgCO 2 during the surgery,but the cumulative time of PgCO 2 beyond 50 mmHg was longer in group B than that in group A.The peak PgCO 2 and cumulative time of PgCO 2 beyond 50 mmHg during ICU were significantly greater in group B than those in group A.The SOFA score on the first day,TMS and stay time in ICU were greater and longer in group B than those in group A.Conclusion With the prolongation of CPB time,perioperative gastric intramucosal CO 2 pressure in patients undergoing CABG become more severe and postoperative SOFA scores are higher with longer stay in ICU predicting organ dysfunction and worse prognosis.