心脏不停跳或停跳体外循环对血浆电解质和酸碱平衡影响

The Influence on the Plasma Electrolyte and Acid-base Balance by CPB With Beating Heart or Arrested Heart

目的 :探讨心脏不停跳或心脏停跳体外循环对血浆电解质和酸碱平衡的影响。方法 :随机选择 93例瓣膜置换心内直视手术患者 ,4 7例采用心脏不停跳体外循环 (BH组 ) ,4 6例采用心脏停跳体外循环 (AH组 ) ,在 CPB中监测平均动脉压、中心静脉压、尿量、鼻咽温 ,并在转前、转机 10 min、复温、停机时分别测定血气、血钾、血钙。结果 :心跳组转机中流量、平均动脉压、转中尿量均较心停组高 ,而转流时间却较短 ,两组比较有显著性差异 (P<0 .0 5 )。 BH组与 AH组比较 ,p H值、PO2 、BE值较转机前有显著升高 ,而 PCO2 却有显著下降 (P<0 .0 5 ) ,接近于正常生理值 ,两组 Hct在转前、转中变化无明显差异 ,血钾、血钙在 BH组中较稳定。结论 :心脏不停跳体外循环比心脏停跳体外循环更接近正常生理状态 ,能保持良好的有氧代谢。

Objective: To study the effects on the plasma electrolyte and acid base balance by CPB with beating heart or arrested heart. Methods:Ninety three patients scheduled to undergo valve replacement open heart surgery,were randomly assigned to two groups: forty seven cases received beating heart CPB (BH group) and forty six cases received arrested heart CPB(AH group).The average BP, CVP, urine volume and nasopharyngeal temperatures in CPB were measured.The changes of blood gas,the concentration of blood kalium and blood calcium were observed before CPB, 10 minutes in CPB,rewarming and after CPB,respectively. Results: In CPB, the flow of perfusion,average BP, urine volume in group BH were significantly higher than that in group AH ( P <0 05), the time of CPB in group BH was significantly shorter than that in group AH( P <0 05); PH, PO 2, and BE raised significantly, PCO 2 decreased significantly to restored the levels of the physiologic value in group BH during CPB ( P <0 05).There were not difference before CPB and during CPB in the two groups on HCT( P >0 05).The concentrations of blood kalium and blood calcium stabilized in group BH during CPB( P >0 05). Conclusion:Beating heart CPB is more approach the normal physiologic state than arrested heart CPB, and maintains a better oxygen consumption,acid base balance and electrolyte metabolism.