围术期重症先天性心脏病氧供与氧耗量维护

The Maintenance of Oxygen Supply and Oxygen Depletion of Perioperative Serious Congenital Heart Disease

目的:探讨围术期常见重症先天性心脏病使用正性肌力药物及血管扩张药硝酸甘油作用下的氧合情况。方法:选择重症先天性心脏病患者20例,手术复跳后连续使用多巴酚丁胺、米力农及小剂量硝酸甘油条件下测定心脏指数(CI)、氧供应量(DO2)、氧耗量(VO2)和氧摄取率(ERO2)。结果:DO2与氧耗量相关性分析体外循环中和体外循环后30 min有高度正相关性(P<0.01);体外循环与体外循环后30 min各数据比较Cl、DO2、VO2前者明显低于后者,ERO2无显著性差异;体外循环后,CI和DO2术后15 h最高,明显高于手术结束时(P<0.05),VO2术后2 h最高,术后15 h最低,且明显高于体外循环结束和术后15 h(P<0.05)。讨论:体外循环后连续应用多巴酚丁胺或米力农难以进行DO2、VO2、CI的正常维护,手术后15 h循环功能不能完全恢复,仍需加强正性肌力药及血管扩张药的治疗。

Objective： Discuss the oxygenation of geneal serious congenital heart disease treated with ln- otrope and vasodilator, glonoine. Method： 20 patients of perioperative serious congenial heart disease wcre selected.After the patients heartbeat being reabled, they were treated with dobutamine, milrinone and little dose glonoine continuously, then CI,DO2,VO2and ERO2 wcrc measured. Results：DO2 and VO2 have high directcorrelation（P〈 0.01）in the process of cxtracoporenl circulation and 30 minutes after the cxtracorporenl circulation. Compare data in and after the extraeorporcal circulation, CI,DO2, VO2 increased obviously and 02 ER had not distinct difference. CI and DO2 achieved maximum in 15 hours after operation and Were muchhigher than the time when operation finished（P〈 0.05）. VO2 reached maximum in 2 hours after operation andminimum in 15 hours alter operation. And the maximum was much higher than the data of extracorporealcirculation finished and 15 hours after operation（P 〈 0.05）. Conclusion：The continuous use of dobutamine ormilrinone has difficulty in maintaining DO2,VO2 and CI. Circulation function can not I＇ CSume completely in 15 hours alter operation. Then, medication of inotrope and vasodi＇lator should be intensified.