丙泊酚对低温体外循环期间胃粘膜酸中毒的影响

The influence of propofol on gastric mucosal acidosis during hypothermic cardiopulmonary bypass

目的 探讨丙泊酚对心内直视手术病人低温心肺转流 (CPB)期间胃粘膜酸中毒的影响。方法 2 0例心内直视手术病人随机分为对照组 (A组 ,n =10 )和丙泊酚组 (B组 ,n =10 )。用芬太尼、咪唑安定、潘库溴铵维持麻醉 ,间断吸入异氟醚。B组于CPB开始至停机前持续静脉注入丙泊酚 5～ 8mg·kg-1·h-1。分别于CPB前 (T1)、停机前 (T2 )和停机后 4 0分钟 (T3)测定PaCO2 和胃粘膜PCO2 (PiCO2 ) ,计算PiCO2 与PaCO2 之差 [P(i a) CO2 ]和胃粘膜pH( pHi)。 结果 A、B两组T2 P(i a)CO2 较组内各时点均明显增高 ,pHi明显降低 (P <0 0 1) ;与A组比较 ,B组T2 、T3P(i a) CO2 显著降低 ,pHi显著增高 (P <0 0 5 ) ;与T1比较 :A组T3P(i a) CO2 仍显著增高 ,pHi显著降低 (P <0 0 5 ) ,B组T3P(i a) CO2 和 pHi基本恢复至T1水平。结论 低温CPB期间持续静脉注入一定剂量的丙泊酚可减轻胃粘膜低灌流和酸中毒。

Objective To investigate the influence of propofol on gastric mucosal acidosis during cardiopulmonary bypass (CPB).Methods 20 patients undergoing cardiac surgery under CPB were randomly divided into control group (group A, n= 10) and propofol group (group B, n= 10).All patients were anesthetized with midazolam/fentanyl/pancuronium/isoflurane.In group B, propofol 5 8mg·kg -1 ·h -1 was infused intravenously during CPB.PaCO 2 and gastric intramucosal PCO 2 (PiCO 2) were measured and gastric intramucosal pH(pHi) and the difference of gastric to arterial PCO 2 [P (i a) CO 2]were calculated before CPB (T 1),at the end of CPB(T 2) and 40 min after completion of CPB (T 3)respectively.Results The P (i a) CO 2 increased and pHi decreased significantly at T 2 compared with those at T 1 and T 3( P< 0 01)in all patients.Between group B and A,there were significant differences in the P (i a) CO 2 and pHi at T 2 and T 3( P< 0 05).P (i a) CO 2 increased and pHi decreased significartly at T3 compared with those at T 1 in group A ( P< 0 05).In group B,P (i a) CO 2 and pHi of T 3 almost returned to the levels of T 1.Conclusions The gastric mucosal hypoperfusion and acidosis during CPB might be decreased by the continuous infusion of propofol in an anesthetic dose.