摘要
目的观察浅低温体外循环中瓣膜置换患者的脑氧代谢及脑糖、脑乳酸的变化。方法择期行瓣膜置换33例,行颈内静脉逆行置管至颈内静脉球部,分别于体外循环前、转机后鼻咽温降至35℃、32℃稳定10min、复温至35℃、停机后30min采取颈内静脉球部血及桡动脉血进行血气分析,测定血糖及乳酸,并计算脑氧摄取率(oxygenextraction,O2Ext)、脑动静脉血糖差(glucosedifferencesbetweenarterialandjugularbulbblood,Ga j)以及乳酸差(lactatedifferencesbetweenarterialandjugularbulbblood,AVDL)。结果颈静脉球部血氧饱和度(jugular bulbvenousoxygensaturation,SjvO2)在32℃时较体外循环前明显升高(P<0.05),复温至35℃则明显下降,有5例出现SjvO2<50%;O2Ext在32℃时明显降低,复温至35℃时则升高显著(P<0.01);Ga j在32℃有极明显的降低(P<0.01),而复温阶段则明显升高(P<0.05);体外循环期间的AVDL均有明显降低(P<0.05)。结论瓣膜置换患者在浅低温体外循环期间脑氧平衡受到明显干扰,复温阶段更为突出。
ObjectiveTo observe the changes of metabolism of cerebral oxygen, glucose and lactate during mild hypothermic cardiopulmonary bypass(CPB) in cardiac valve replacing surgery. MethodsThirty-three patients scheduled for cardiac valve replacing with CPB were selected. The data of arterial and jugular venous oxygen saturation(SjvO 2),oxygen content,glucose and lactate were recorded before CPB,at pharynx temperature of 35 ℃ during cooling, 10 minutes of temperature reaching a stable temperature of 32 ℃,rewarming to 35℃ and 30 minutes after CPB. Cerebral oxygen extraction(O 2Ext) and glucose differences between arterial and jugular bulb blood(Ga-j), lactate differences between arterial and jugular bulb blood (AVDL) were calculated. ResultsSjvO 2 was higher than that before CPB in 32 ℃(P< 0.05),but reduced in rewarming to 35 ℃(P< 0.05). SjvO 2 was lower for 50 % in five of thirty-three patients. O 2Ext decreased in 32 ℃(P< 0.05) and increased in rewarming to 35 ℃(P< 0.01) very significantly. Ga-j was reduced very significantly in 32 ℃(P< 0.01) and increased in rewarming to 35 ℃(P< 0.05). AVDL was reduced significantly during cooling stage(P< 0.05). ConclusionThe balance between cerebral oxygen supply and demand was interfered during mild hypotheric cardiopulmonary bypass in cardiac valve replacing surgery.
出处
《河北医科大学学报》
CAS
2005年第3期200-203,共4页
Journal of Hebei Medical University
关键词
体外循环
脑
氧/代谢
心脏瓣膜/外科学
extracorporeal circulation
brain
oxygen/metab
heart valves/surg