体外循环中酸碱平衡的α稳态处理

MANAGEMENT OF THE ACID-BASE BALANCE BY ALPHA-STAT DURING CARDIOPULMONARY BY PASS

为探讨α稳态处理体外循环（ＣＰＢ）中酸碱平衡的合理性，将１０３例ＣＰＢ心脏直视手术中不同温度下血气结果筛选出分别符合２种稳态标准的８３例，其中符合α稳态标准７２例，符合ｐＨ稳态标准１１例。对α稳态组的血气作温度校正前后比较；将α稳态组与ｐＨ稳态组复温后的血气作对比；计算２个稳态组的ＯＨ／Ｈ。结果，３４℃以下低温时ｐＨ稳态的ｐＨ值升高及ＰａＣＯ２下降显著（Ｐ＜０．０１）；ｐＨ稳态组复温后更容易出现酸中毒（Ｐ＜０．０１）；α稳态组的ＯＨ／Ｈ在正常范围内而ｐＨ稳态组则明显偏离（Ｐ＜０．０１），呈酸中毒状态。分析认为，α稳态比ｐＨ稳态更符合低温生理，且操作简便，也便于ＣＰＢ中的灌注管理。

To evaluate the reasonable management of the acid-base balance by α-stat during cardiopulmonary bypass (CPB), 83 cases of CPB accord with the standards of α-stat and pH-stat were selected from 103 cases of CPB under different temperature, and were classified into α-stat group (n=72) and pH-stat group (n=11). The blood gases of α-stat group were compared between the before and the after temperature correction. The after-rewarming blood gases were compared between α-stat group and pH-stat group. OH/H of the two groups were calculated. The result shows that in low temperature (below 34℃), the pH-value increases and PaCO2 decreases significantly in pH-stat group (P<0.01). Acidosis may occur easily in pH-stat group after rewarming. OH/H in α-stat group are in normal range but OH/H in pH-stat group deviate significantly (P<0.01), known as acidosis. The analysis indicated that α-stat is preferred to pH-stat in hypothermic physiologic condition, its operation was simple and its perfusion management in CPB was easy.