体外循环与非体外循环冠状动脉旁路移植术补钾影响因素的比较

Comparison of influence factors of potassium supplement during conventional coronary artery bypass grafting and off-pump coronary artery bypass grafting

目的探讨常规冠状动脉旁路移植术（CCABG）与非体外循环冠状动脉旁路移植术（OPCABG）围术期钾离子变化特点与补钾影响因素。方法50例接受CABG患者，分为CCABG组和OPCABG组，每组25例。术中根据血气结果补钾，维持血清钾离子浓度在4．0～5．0nunol／L。记录并比较两组术中及术后液体出入量、补钾量、单位时间补钾量（补钾量／手术时间）、尿钾浓度、尿排钾量（总尿量×平均尿钾浓度）以及心肺转流（CPB）指标，分析两组术中补钾量的独立影响因素。结果CCABG组术中补钾量及单位时间补钾量均高于OPCABG组，但其CPB前后单位时间补钾量低于OPCABG组（P〈O．05）；CCABG组桥血管数、手术时间、术中尿量、尿排钾量及术后24h补钾量均大于OPCABG组，术中平均尿钾浓度和最低体温低于OPCABG组（P〈0．05）。多元线性回归分析显示尿量和人室血钾浓度是OPCABG组术中补钾量的独立影响因素；年龄和CPB转机时间是CCABG组术中补钾量的独立影响因素（P〈0．05）。结论CABG围术期需积极补钾。OPCAtG中应根据基础血清钾水平结合尿量尽早开始补钾；CCABG中应根据CPB时间合理补钾。

Objective To compare the change of plasma postassium and potassium supplement during conventional coronary artery bypass grafting （CCABG） and of Lpump coronary artery bypass grafting （OPCABG）. Methods Fifty patients undergoing CABG were randomly divided into two groups： CCABG group and OPCABG group, 25 cases each. Potassium was administrated according to the results of blood gas analysis and the concentration of plasma potassium was maintained 4.0 5.0 mmol/L. The values of fluid infusion, urine output, the concentration of urine potassium, potassium lost from urine, potassium supplement, and cardioputmonary bypass （CPB） parameters intra and post-operation were recorded. Results In CCABG group, the whole and average intra-operative potassium supplement is higher than that in OPCABG group, while the average potassium supplement before and after CPB is lower than that in OPCABG group（P〈0.05） ; the potassium supplement in the first 24 hs post-operation was higher than that in OPCABG group（P〈0.05）. The independent influence factors of intra-operative potassium supplement were age and CPB time in CCABG group; and the concentration of blood potassium after induction and urine output in OPCABG group. Conclusion The administration of potassium is quite necessary in CABG peri-operatively. For OPCABG, potassium should be used at the beginning of the surgery according to the urine output and the basic concentration of potassium; for CCABG, potassium should be used according the time of CPB.