小儿常温体外循环手术中血浆乳酸水平的监测

Alteration of Plasma Lactate Level During Cardiopulmonary Bypass in Children in Normothermia

目的观察小儿常温体外循环手术中不同时段血浆乳酸水平的变化。方法将24例先天性心脏病患儿分为两组:常温组(A组)17例和低温组(B组)7例。两组在体外循环(CPB)前、主动脉阻断后5min、停CPB前,分别采动脉血样检测血浆乳酸的水平。结果两组在主动脉阻断后5min和停CPB前的血浆乳酸水平均较CPB前明显升高(P均<0.05);A组在主动脉阻断后5min和停CPB前的血浆乳酸水平均明显高于B组(P均<0.05);A组停CPB前血浆乳酸水平较主动脉阻断后5min有显著下降(P<0.05)。结论常温转流要较低温转流更符合生理、血浆乳酸水平检测,有助于随时调整转流管理策略,使组织灌注在较佳状态,减少转流后并发症。

Objective To detect the changes of plasma Lactate level in different periods during CPB in children in normothermia.Methods Tweenty-four cases were divided into 2 groups,Normothermic group(group A,n=17) and hypothermia group (group B n=7).Blood was sampled for detection of plasma lactate level before CPB, after aortic clamp for 5 minutes,before the end of CPB respectively.Results There were statistic differences:(1)there were marked increased in plasma lactate level after aortic clamp for 5 minutes and before the end of CPB,compared with that before CPB in each group,(P<0.05,P<0.05);(2)The lactate decreased before the end of CPB compared with after aortic clamp in group A(P<0.05).Conclusion The normothermic is more physiologic status than hypothermia in bypass and monitor the changes of lactate during bypass is helpful for management bypass good cellular perfusion, and less complications postoperatively.