婴幼儿法鲁氏四联症术后氧代谢特点的初步分析

Preliminary analysis of oxygen metabolize in tetralogy of fallot after open heart surgery

目的探讨婴幼儿法鲁氏四联症术后早期氧代谢动力学的变化特点。方法应用4F Swan-Ganz四腔漂浮导管及PHLIPSM:7008A监护仪,总结分析我院2002年1月～2006年5月23例婴幼儿期法鲁氏四联症术后72h内氧代谢动力学的变化特点。结果①术后72h内氧供指数(DO2I)与氧耗指数(VO2I)始终表现为直线相关关系,P<0.05;②术后4～8hVO2I最高,同时氧摄取率(ERO2)明显增加,而DO2I并未显著增加;③心排指数(CI)术后8～12h降至最低,为围手术期72h最低谷,并伴有乳酸(LAC)升高。④术后8～12h内LAC升高,动静脉血氧含量差(Ca-vO2)增加,混合静脉血氧饱和度(SvO2)降低。结论婴幼儿期法鲁氏四联症患者术后存在病理性氧供依赖,易出现组织缺氧,应及时纠正氧代谢失衡,改善组织供氧。

Objective To determine the rule of oxygen metabolize in tetralogy of fallot（TOF）congenital heart disease af- ter open heart surgery. Methods Using 4F Swan-Ganz pulmonary catheter and PHLIPS M：7008A monitor to analyse the variety of oxygen metabolic indexes during the 72 hours of post-operation. Results ①There was an obvious beeline relation between the DO2I and VO2I during the 72 hours after open heart surgery（P〈0.05）.②In the first 4 hours the VO2I was highest,as well as the ERO2, but DO2I didn＇t display significant increasing. ③CI was more lower during the 8-12 hours than before,and it was the lowest point in the whole period of post-operation,but the LAC shows more higher. （~）CI was lower during the early 12hours than the others,although it remained in the nonnol range.But the oxygen indexes changed at the same time,it showed the increasing in LAC,Ca-vO2 and the decreasing in SvO2. Conclusion Pathological dependence on oxygen was existent in postoperative of TOF during childhood. Prone to hypoxia, should rectify the oxygen metabolism imbalances and improve tissue for oxygen.