静动脉二氧化碳分压差在胸腔镜心脏手术后的应用价值

The application value of the differential pressure between the arterial carbon dioxide pressure in the thoracic cavity after cardiac surgery

目的:探讨中心静脉-动脉血二氧化碳分压差[P(cv-a)CO2]在胸腔镜心脏手术后的应用价值。方法:选择2014年1月至2014年12月,本院施行胸腔镜体外循环心脏手术后患者50例。分别于术后即刻、6h、12h、18h及24h抽取动静脉血气,计算P(cv-a)C02,根据P(cv-a)C02平均值将患者分为A组(Pcv-a CO2≤6mm Hg,1mm Hg=0.133k Pa)和B组(Pcv-a CO2﹥6mm Hg),比较两组手术时间、体外循环时间、主动脉阻断时间、术后平均动脉压、中心静脉压、EF、乳酸、呼吸机应用时间及监护室滞留时间。结果:A组较B组呼吸机辅助时间、监护室滞留时间明显缩短(P分别为:0.043和0.039),A组与B组手术时间、体外循环时间、主动脉阻断时间,差异无统计学意义(P>0.05),A组与B组术后平均动脉压、中心静脉压、EF、乳酸无明显相关性。结论:P(cv-a)C02可作为评估胸腔镜心脏手术后患者组织灌注与疾病严重程度的临床指标。

Objective： To investigate the value of central venous arterial blood carbon dioxide partial pressure difference Pcv-a CO2 in the application of thoracic surgery after cardiac surgery. Methods： Fom January 2014 to December,50 cases of patients with cardiac surgery in our hospital from to were selected. Respectively on postoperative 0h,6h,12 h,18h,24 h extraction dynamic venous blood gas to calculate Pcv-a CO2. According to P cv- a CO2 average,the patients were divided into group A（ Pcv-a CO2 is less than or equal to 6 mmHg） and group B（ Pcv- a CO2 6 mm Hg）,compared two groups of operation time,extracorporeal circulation time and aortic cross clamping time,operation,mean arterial pressure,central venous pressure,EF,lactic acid,ventilator application time,ICU retention time. Results： Compared with group B,the retention time of breathing machine in A group was significantly shorter（ P value was 0. 043 and 0. 039 respectively）. There was no significant difference in operation time,cardiopulmonary bypass time and aortic occlusion time between A group and B group（ P〈0. 05）. There was no significant correlation between mean arterial pressure,EF,lactic acid in group A and group B. Conclusion： Pcv- a CO2 can be used as a clinical index for evaluating the degree of tissue perfusion and disease severity in patients after cardiac surgery.