心脏体外循环手术后早期检测中心静脉血氧饱和度的临床价值

Clinical value of early detection of central venous blood oxygen saturation after cardiopulmonary bypass

目的探讨心脏体外循环手术后早期检测中心静脉血氧饱和度(ScvO_2)的临床价值。方法选取60例2015年1月至2017年12月在我院行体外循环心外科手术治疗的患者为研究对象,根据ScvO_2水平将其分为A组(ScvO_2≤65%,25例)与B组(ScvO_2>65%,35例)。观察患者术后不同时间段ScvO_2及SaO_2水平,比较两组患者ICU治疗时间、呼吸机使用时间及术后并发症发生情况。结果相较于术后2 h,患者术后6 h的ScvO_2水平逐渐下降,术后12 h时逐渐回升,差异均有统计学意义(P<0.05);术后2、6、12 h,患者的SaO2水平无显著差异(P>0.05)。B组的ICU治疗时间及呼吸机使用时间均显著短于A组,差异具有统计学意义(P<0.05)。B组低心排血量综合征、低氧血症、心律失常及肝肾功能损害发生率均显著低于A组,差异具有统计学意义(P<0.05)。结论 ScvO_2是衡量心脏体外循环手术后早期患者组织氧供需平衡较为敏感的指标,ScvO_2过低则并发症发生率增高,预后较差,因而ScvO_2可作为预测并发症和预后的指标,值得在临床上推广。

Objective To explore the clinical value of early detection of central venous blood oxygen saturation(ScvO2)after cardiopulmonary bypass. Methods Sixty patients who underwent cardiac surgery under cardiopulmonary bypass from January 2015 to December 2017 were selected as the study objects. According to the level of ScvO2, patients were divided into group A(ScvO2≤65%, 25 cases) and group B(ScvO2>65%, 35 cases). The levels of ScvO2 and SaO2 at different time points after operation of patients were observed. The treatment time of ICU, the use time of ventilator and the occurrence of complications were compared between the two groups. Results Compared with 2 h after operation, the level of SCvO2 decreased gradually at 6 h after operation, and increased gradually at 12 h after operation, the differences were statistically significant(P<0.05);there were no significant differences in the levels of SaO2 at 2, 6 and 12 h after operation(P>0.05).The ICU treatment time and ventilator use time in the group B were significantly shorter than those in the group A, and the differences were statistically significant(P<0.05). The incidences of low cardiac output syndrome, hypoxemia, arrhythmia and liver and kidney function damage in the group B were significantly lower than those in the group A, and the differences were statistically significant(P<0.05). Conclusion ScvO2 is a sensitive index to measure the balance of tissue oxygen supply and demand in early patients after cardiopulmonary bypass. If ScvO2 is too low, the incidence of complications will increase and the prognosis will be poor. Therefore, ScvO2 can be used as a predictor of complications and prognosis, and it is worth popularizing in clinic.