危重患者心脏手术后氧代谢监测的价值

Values of oxygen metabolism in treatment of critical patients after open heart surgery

目的 探讨心脏直视术后危重患者氧供需平衡的重要性和临床价值 .指导救治 ,评估疗效及预后 ,预防多脏器功能衰竭 ( MOF)的发生 ,使 ICU监测水平跨跃到细胞水平 .方法 对 148例心脏直视术后危重患者入 ICU后 ,分阶段动态监测动脉 ,混合静脉血气 ,心输出量 ,胃粘膜 p H值 ,对氧代谢动力学各项监测值之间相关关系进行分析 .结果 动 -静脉血气及其差值的变化与循环 ,呼吸功能变化呈正相关关系 ;APACHE 评分高 ,Sv O2 低的极重患者死亡率明显高于APACHE 评分低 ,Sv O2 偏高的较重患者 ;Phi值的低、高与在 ICU时间、伴发症发生率、预后呈显著相关性 ;A- Vp H,A-V PCO2 与 VO2 依赖 DO2 的发生呈显著负相关性 .结论 动态观察氧供需及分析 DO2 ,VO2 两者之间的相关关系 ,能真正反映机体氧合情况 ;维持全身氧供需平衡是氧代谢监测的关键 ;维持局部组织器官氧供需平衡是预防

AIM To investigate the clinical values of oxygen supplydemand balance in critical patients after open heart surgery, to guide the treatment, to evaluate the therapeutic effectiveness and prognosis, and to prevent the occurrence of multiple organ failure (MOF). METHODS On admission to ICU, the arterial, and mixed venous blood gas, cardiac output and pH of gastric mucosa were observed in 148 patientsafter open heart surgery. The indexes of oxygen metabolic dynamics were noted and their interrelationships were analyzed. RESULTS Changes of arteriovenous blood gas differences were positively correlated with those of circulatory and respiratory functions; AVpH and AV PCO 2 were significantly correlated with VO 2 dependent DO 2. CONCLUSION Dynamic observation of oxygen supplydemand and analysis of interrelationship of DO 2 and VO 2 could reflect the practical systemic oxygenation; Oxygen metabolism monitoring was critical to the maintenance of systemic balance of oxygen supply and demand; The maintenance of oxygen supplydemand balance in regional tissues and organs was the key point for preventing the occurrence of MOF.