亚低温对心脏外科术后低心排的治疗评价

Effects of mild hypothermia on low cardiac output after cardiac surgery

目的探讨亚低温对心脏外科术后低心排的治疗价值及其疗效。方法选择2009年5月至2011年2月本院心脏外科术后应用大剂量血管活性药物及主动脉内球囊反搏术（IABP）治疗仍存在低心排，而给予亚低温治疗的患者12例。监测患者亚低温治疗前后心排血指数（cI）、混合静脉血氧饱和度（SiO2）、尿量的变化等。结果在应用亚低温治疗过程中，将患者膀胱温度降至33—35℃以降低组织的氧需求。与治疗前比较，经亚低温治疗后患者CI（ml·s-1·m-2）明显增加（38．34±5．00比30．0l±5．00），Si0：明显升高（0．64±0．07比0．54±0．08），尿量（ml·kg-1·h-1）明显增加（3．0±2．1比1．5±1．1，均P〈0．05）；而心率、平均动脉压、动脉血氧分压则无明显改变。结论亚低温治疗可有效改善心脏外科术后低心排患者循环功能，且操作简单。

Objective To evaluate the effectiveness of mild hypothermia on low cardiac output in patients after cardiac surgery. Methods Twelve patients manifesting low cardiac output after cardiac surgery despite of the use of massive doses of catecholamine and intra-aortic balloon pump （IABP） underwent mild hypothermia during May 2009 to February 2011. Changes in hemodynamie parameters of the patients were measured, including cardiac index （CI）, mixed venous oxygen saturation （SVO2） and urine volume. Results In the process of mild hypothermia treatment, bladder temperature of patients was lowered to 33-35 ~C in order to reduce the body oxygen demand. The CI （ml＂ s-l＂ m-2） of patients after mild hypothermia treatment was increased obviously （38.34 ±.00 vs. 30.01±5.00）, the same as SrO2 （0.64±0.07 vs. 0.54 ±0.08） and urine output （ml·kg-1·h-1： 3.0 ±2.1 vs. 1.5 ±1.1, all P〈0.05）. However, there was no significant change in heart rate, mean arterial pressure and blood oxygen pressure. Conclusion Mild hypothermia is an effective and simple procedure to improve the cardiac function in patients after cardiac surgery complicated with low cardiac output.