不同肺动脉高压病人心瓣膜手术期间氧代谢及血液动力学的变化

Changes of oxygen metabolism and hemodynamics in patients with different pulmonary hypertension undergoing cardiac valve replacement

目的 研究不同肺动脉高压病人心瓣膜手术期间氧代谢及血液动力学的变化。方法 36例择期行心瓣膜手术病人根据术前肺动脉平均压 (PAMP)分为两组 ,组ⅠPAMP <4 0kPa ,组ⅡPAMP>4 0kPa ,采用Swan Ganz导管及反向Fick方法 ,麻醉手术期间对氧代谢及血液动力学进行测定。结果 麻醉前组Ⅱ的DO2 、PvO2 和O2 ER与组Ⅰ相比存在显著性差异 (P <0 0 5 )。CPB前组Ⅰ的DO2 ,组Ⅱ的pH值均显著下降 ,组Ⅱ的PaCO2 较麻醉前增高 (P <0 0 5 )。CPB后组ⅡVO2 和PaCO2 较CPB前明显增加 ,pH则显著降低 (P <0 0 1) ,两组的O2 ER呈增高趋势 ,DO2 、VO2 较CPB前显著升高 (P <0 0 5 )。在血流动力学参数中组Ⅱ的PAMP、PVRI和RVWI在麻醉前、后均显著高于组Ⅰ。结论 中、重度肺动脉高压病人麻醉前DO2 明显低 ,O2 ER代偿性增加 ,术中更易发生DO2 不足和增加无氧代谢。体、肺循环阻力越高表明病情越重 。

Objective To investigate the changes with oxygen metabolism and hemodynamics in patients with different pulmonary hypertension undergoing cardiac valve replacementMethods Thirty-six patients,scheduled for selective cardiac valve operation ,according to PAMP of pre-anaesthesia were divided into two groups,groupⅠ(n=13) PAMP≤40kPa,groupⅡ(n=23) PAMP>40kPaOxygen metabolism and hemodynamics were measured with Swan-Ganz catheter techniques and reverse Fick principleResults Before anaethesia, oxygen delivery(DO_2), mixed venous oxygen pressure (PvO_2) and oxygen extraction ratio(O_2ER) in group Ⅱ were significantly lower than those in group Ⅰ (P<005) Before CPB, DO_2 in group Ⅰ and pH in group Ⅱ significantly decreased compared with the baselinesPaCO_2 in group Ⅱ was higher than that in group Ⅰ(P<005) After CPB, VO_2 and PaCO_2 in group Ⅱ increased markedly compared with the baselines; pH of groupⅡ was lower than that in group Ⅰ; in both groups O_2ER trended to increase, DO_2 and VO_2 increased significantly compared with the baselines (P<005)PAMP,PORI and RVWI in groupⅡ were significantly higher than those in group Ⅰ before and following CPBConclusions Before anesthesia ,there are a signifcant decrease of DO_2 and a concomitant compensatory increase of O_2ER in the patients with moderate or severe pulmonary hypertension, who have a trend of decrease of DO_2,and increase of anerobic metabolism during operationThe higher systemic vascular resistance and pulmonary resistance,the severer conditions of patients,the liabler to develop oxygen metabolism disorder