体外循环中空气法胃粘膜pH值与氧供 氧耗的变化

Change of gastric air tonometric pH,oxygen delivery and oxygen consumption during cardiopulmonary bypass(CPB)

目的观察体外循环(CPB)中空气法胃粘膜pH值与氧供、氧耗的变化了解体外循环期间胃粘膜的血流灌注。方法选择择期行体外循环心脏手术30例,麻醉后置入TONO胃管通过空气法胃粘膜张力模块自动持续监测胃粘膜二氧化碳分压(PgCO2),在监护仪中输入麻醉诱导后30min、体外循环30min、60min、停体外循环后30min和60min时间点的动脉和混合静脉血气分析结果,计算获得各时点的胃粘膜pH值(pHi)、氧供(DO2)和氧耗(VO2)等数据。结果PgCO2在CPB期间明显低于术前(P<0.01),停CPB后恢复到术前水平;pHi的变化体外环循期间显著升高(P<0.01),停CPB后恢复术前水平;DO2和VO2变化:CPB期间明显低于术前(P<0.01),停CPB后明显高于CPB期间(P<0.01),停CPB60min后明显高于术前(P<0.01)。结论本研究中的病例在低温体外循环期间未存在胃肠粘膜血流灌注不足。

Objective To observe the change of gastric air tonometric pH, oxygen delivery , oxygen consumption and gastric mucosal perfusion during cardiopulmonary bypass （CPB）, during CPB. Methods Thirty elective cardiac surgery patients were observed. Gastric PCO2 was measured from a nasogastric tube by an automated system of air tonometry. Record the arterial and mix venous blood - gas results in after indication 30 min, CPB30 min, CPB 60 Min, 30 Min and 60 rain after the end of CPB. Input these bloed - gas results to the monitor calculated the pHi, oxygen delivery and oxygen consumption in these observe points. Results PgCO2 during CPB was significantly lowered compared with that of preoperation （ P 〈 0.01 ）, and returned to preoperation level when after CPB. pHi during CPB was significant up versus preoperation （ P 〈 0.01）, and returned to preoperation level when after end the CPB. DO2 and VO2 in during CPB were significantly lower preoperation （ P 〈 0.01）, those after CPB were significantly higher than those during CPB （ P 〈 0.01）. Conclusion The patient＇ s gastric mucosal perfusion is maintained well during hypothennic CPB.