麻醉恢复期阶梯式提高吸氧浓度对失血性休克复苏患者的心肌保护作用

The cardiac protective effect of step-wise elevation of inhaled oxygen concentration on the recovery of patients with hemorrhagic shock

目的探究麻醉恢复期阶梯式提高吸氧浓度对失血性休克复苏患者的心肌保护作用。方法选取2014年4月至2016年4月收入医院的失血性休克患者共120例为研究对象,将其平均分为4组,常氧组、低氧组、高氧组和阶梯组。在麻醉恢复期,常氧组吸氧浓度为40%,高氧组吸氧浓度为60%,低氧组吸氧初始浓度为20%,以后每10min增加3%,直至达到40%。阶梯式提高吸氧浓度组首先采用20%氧浓度吸氧,以后每5 min增加3%,直至达到60%。监测复苏1 h后的血清肌酸激酶MB同工酶(CK-MB)、心肌肌钙蛋白(c Tn)、C反应蛋白(CRP)、平均动脉压(MAP),采用心脏彩色多普勒超声测量心输出量、左室射血分数(LVEF)、左心室短轴缩短率(FS)以及左心室心肌活动指数(Tei index)。结果阶梯组的CK-MB、cTn、CRP和乳酸水平均低于常氧组、低氧组和高氧组,差异有统计学意义(P<0.05)。阶梯组的MAP、心输出量、LVEF与高氧组相同,差异无统计学意义(P>0.05);FS和Tei Index高于高氧组、常氧组和低氧组,差异有统计学意义(P<0.05)。结论阶梯式提高吸氧浓度对失血性休克复苏患者的心肌具有保护作用,可以明显改善血流动力学。

Objective To investigate the protective effect of step-wise increasing of oxygen administration（GIOA） on patients＇ myocardium during hemorrhagic shock recovery. Methods 120 in-patients with hemorrhagic shock were in- cluded. They were divided into four groups randomly, the Normo, Hypo, Hypero and GIOA. During hemorrhagic shock recovery, oxygen concentration administered in the Normo was 40%; oxygen concentration administered of Hypero was 60%; primary oxygen concentration administered of Hypo was 20%, increased by 3% every 10 minutes until 40%. Primary oxygen concentration administered of GIOA was 20%, increased by 3% every 5 minutes until 60%. CK-MB, cTn, CRP, MAP were monitored. Cardiac output, left ventricular ejection fracton（LVEF）,fractional shortening（FS） and Tei Index were measured by electrocardiogram. Results CK-MB, cTn, CRP and lactic acid of GIOA were lower than those of Nor- mo, Hypo and Hypero. The difference was statistically significant （P 〈 0.05）. MAP, cardiac output and LVEF of GIOA were the same as those of Hypero. The difference was not statistically significant （P 〉 0.05）. FS and Tei Index were higher than those of Hypero, Normo and Hypo. The difference was statistically significant（P 〈 0.05）. Conclusion Gradually in- creased oxygen administration has protective effect on patients＇ myocardium during hemorrhagic shock recovery by im- proving hemodynamics.