术后危重病人氧供、氧需的临床观察

Clinical Observation of Post-operative Critical Patient's Oxygen Supply and Oxygen Demand

目的观察术后危重病人氧代谢监测变化,指导救治,评估疗效及预后.方法选择10例我科收治的术后危重病人,分别于术后2、6、12、24、36、48h监测各项血流动力学及氧代谢指标,按生存组与死亡组分别处理各项指标结果,以均数±标准差(x±s)表示.组间比较采用配对t检验.应用PEMS统计软件包进行统计学处理,观察两组病人氧供需变化.结果生存组在血液动力学及氧代谢方面与死亡组比较均有着明显的差异.生存组中,患者血液动力学逐渐平稳,氧供指数(DO2)和氧耗指数(VO2)均明显升高,血乳酸水平较低,经综合治疗后患者得于存活,而死亡组数据显示,患者血液动力学不稳定,DO2和VO2的提高非常困难,且血乳酸水平持续较高,提示组织缺血缺氧严重,细胞功能衰竭不可逆,虽采取多种措施进行综合治疗,但患者最终死亡.结论术后动态观察氧供需及分析DO2、VO2两者之间的相关关系,能反映机体氧合情况,有助于对患者的病情及预后进行评估,指导救治危重病人,提高术后危重病人存活率.

Objective To observe the oxygen metabolism which was monitored the changing of post-operative critical patient, instruct treatment and evaluate the curative effect and prognosis. Method Thirty cases of post-operative critical patient were selected which admitted in our unit. Each blood dynamics and oxygen metabolism index were monitored at 2, 6, 12, 24, 36 and 48 hours respectively. According to the survival group and the death group to deal with every monitored results, indicated by mean value ± standard deviation （x ^- ± s）. among group compared with pairs T-test. Carried on statistics processing by PEMS statistics software. two groups of the patient oxygen supply and demand changes were observed. Result Every index of monitored see the attached table. In the table the results showed that survival group versus the death group had the significant difference in blood dynamics and oxygen metabolism. In the survival group, patients＇ blood dynamics were stable gradually. DO2 and VO2 increased obviously. The blood lactic acid level was low. after complex therapy the patients were survival, however. In the death group the data demonstrated that patients＇ blood dynamics were unstable. The DO2 and VO2 was difficult to increase, and the blood lactic acid kept at high level, it showed that the tissues were seriously in the condition of isehemia and anoxemia, the cell function failure was irreversible, although many kinds of complex therapy were carried the post-operative patient oxygen supply and demand on. The patient still died finally. Conclusion To observe dynamically and to analyze the relationship between DO2 and VO2. can truly reflect the organism oxygenation. To evaluate the patient＇s condition and prognosis. To instruct critical patient treatment. So to enhance the post-operative critical patient survival rate.