失血性休克患者术中氧代谢监测与调控

Intraoperative oxygen metabolism monitor and regulation in patients with hemorrhagic shock

目的研究失血性休克患者术中氧代谢变化。方法10例外科失血性休克患者,置入Swan-Ganz导管,经液体复苏、循环氧代谢等治疗,了解治疗前后氧代谢的变化。结果肺动脉楔压(PAWP)从(0.6±0.2)kPa上升为(1.5±0.3)kPa,心脏指数(CI)从(2.0±0.3)L.min-1.m-2上升为(4.5±0.8)L.min-1.m-2(P<0.05)。氧代谢指标变化:氧供指数(DO2)由(260.4±67.0)ml.min-1.m-2显著上升至(624.5±151.2)ml.min-1.m-2(P<0.05)。氧耗指数(VO2)由(96.4±50.4)ml.min-1.m-2上升为(150.9±43.0)ml.min-1.m-2。结论通过术中氧代谢的监测,可改变我们对休克的传统评估方式,由以往的血流动力学调整转向氧代谢状态的调控。

Objective To investigate the intraoperative oxygen metabolism in patients with hemorrhagic shock. Methods Ten patients with hemorrhagic shock were intubated with Swan - Ganz catheter and managed by administering liquid resuscitation and circulation and oxygen metabolism therapies. The parameters of oxygen metabolism were monitored. Results A series ofimprovenents were noticed during the treatment. The Pulmonary arterial wedge pressure （PAWP） was increased from （0.6 ± 0.2） kPato （1.5±0.3） kPa; cardiac index （CI）, from （2.0±0.3） L·min^-1·m^-2 to （4.5±0.8） L·min^-1·m^-2（P〈 0. 05）. The oxygen supply index （ DO2 ） was increased from （260.4 ± 67. 0） ml· min^-1· m^ - 2 to （624 ± 151.2 ） ml·min ^-1· m^- 2 （ P 〈 0.05） ; oxygen consumption index （VO2）, from （94.6 ± 50.4） ml· min^-1 ·m^- 2 to （ 150.9 ± 43.0） ml· min^-1· m^ -2. Conclusion The eurrent practice of intraoperative oxygen metabolism monitor has revised the traditional hemodynamic approach to the evaluation of shock Condition, and thus, has shifted the target of shock treatment from simple hemedynamie adjustment to oxygen metabolism regulation.