心脏手术快通道麻醉体外循环中平均动脉压与血浆乳酸浓度的关系研究

Correlation between mean artery pressure and plasma lactate concentration of heart surgery patients with fast track anaesthesia during extracorporeal circulation

目的探讨心脏手术快通道麻醉体外循环中平均动脉压(MAP)与血浆乳酸浓度的相关性,为临床工作提供一定参考。方法选取2014年10月‐2017年1月于该院接受治疗的114例心脏手术患者作为研究对象,采用随机数字表法分为A、B两组,A组若MAP>80 mm Hg则用硝普钠将MAP降至80 mm Hg以下,B组为对照组。所有患者均采取快通道心脏麻醉方法进行麻醉,调节麻醉药用量,使脑电双频指数值维持在56~64,记录患者体外循环开始10、20、30、40、50以及60 min时的MAP水平,同时抽取患者血液并测定其在不同时点的血浆乳酸浓度。比较心脏手术患者行快通道麻醉时体外循环中MAP与血浆乳酸浓度之间的相关性。结果心脏手术快通道麻醉患者体外循环中MAP与血浆乳酸浓度之间存在正相关关系(P<0.05)。通过测定心脏手术快通道麻醉患者体外循环中MAP与血浆乳酸浓度关系能够为体外循环期间的血压控制提供依据。结论心脏手术快通道麻醉体外循环中MAP与血浆乳酸浓度之间存在正相关关系,通过测定患者血浆乳酸浓度能够指导术中合理应用控制性降压,保证组织器官得到良好灌注。

[Objective] To discuss the correlation between mean artery pressure （MAP） and plasma lactate concentration during extracorporeal circulation in heart surgery with fast track anaesthesia, and provide a reference for clinical work.[Methods] A total of 114 cases of cardiac surgery patients who were treated in our hospital from October 2014 to January 2017 were selected as the study objects, they were divided into group A and group B, patients of group A with MAP〉 80 mmHg were treated with sodium nitroprusside to reduce MAP to below 80 mmHg, and group B was the control group. All the patients were anesthetized with fast track anesthesia, anesthetic dosage was adjusted, and the bispectral index value was maintained between 56 and 64, the MAP levels of patients with extracorporeal circulation at 10 rain, 20 rain, 30 min, 40 rain, 50 min and 60 rain were recorded, at the same time, blood samples were collected and the plasma lactate concentration at different time points were measured. The correlation between MAP and plasma lactate concentration during cardiopulmonary bypass （CPB） of patients with cardiac surgery was compared. [Results] There was positive correlation between the MAP and plasma lactate concentration during extracorporeal circulation of heart surgery patients with fast track anaesthesia （P 〈0.05）, and plasma lactate concentration was an important observation index for the prognosis of patients. The relationship between MAP of extracorporeal circulation of patients with cardiopulmonary bypass surgery and plasma lactate concentration was measured and it provided evidence for the control of blood pressure during cardiopulmonary bypass. [Conclusion] There is positive correlation between the MAP and plasma lactate concentration during extracorporeal circulation of heart surgery patients with fast track anaesthesia, detecting the plasma lactate concentration of patients can guide the rational application of controlled hypotension, and it can ensure good perfusion of tissues and organs.