浅低温心脏不停跳心内直视手术对脑氧代谢的影响

Effects of mild hypothermic cardiopulmonary bypass for beating open heart surgery on cerebral oxygen metabolism

目的 观察浅低温心脏不停跳心内直视手术对脑氧代谢的影响。方法 择期心内直视手术病人40例,随机分为浅低温不停跳组(观察组,20例)和低温停跳组(对照组,20例),分别于CPB前、降温至32℃、低温期、复温至34℃和36℃及CPB后30分钟六个时点测定动脉和颈内静脉血气,并计算动脉-颈内静脉血氧含量差(Da—jvO_2)和脑氧摄取率(O_2ER)。结果 降温期和低温期两组病人SjO_2显著升高(P<O.05,P<O.01),Da-jvO_2和O_2ER显著降低(P<O.05,P<O.01)。低温期对照组SjO_2明显高于观察组(P<0.01),Da-jvO_2和O_2ER明显低于观察组(P<0.01)。复温期对照组SjO_2较观察组显著降低(P<O.05);Da-jvO_2和O_2ER较现察组显著升高(P<O.05)。结论 浅低温心脏不停跳心内直视手术方式对脑氧代谢的干扰较传统的低温体外循环方式轻。

Objective To study the effects of mild hypothermic cardiopulmonary bypass (CPB) for beating open heart surgery on cerebral oxygen metabolism. Methods Forty patients underwent cardiopulmonary bypass were randomly divided into two groups. Mild hypothermic beating heart group and hypothermic static heart group. The changes of arterial and jugular venous hemoglobin saturation (SjO2), oxygen content were observed before CPB, during cooling stage, stable hypothermia, re-warming stages and after CPB. The arterial-jugular venous oxygen content differences (Da-jvO2) and cerebral oxygen extraction rate (O2 ER) were calculated Results During cooling stage and stable hypothermia, SjO2 increased and Da-jvO2, O2ER decreased significantly in both groups. During stable hypothermia SjO2 in static heart group was higher than that in beating heart group (P<0. 01) ,Da-jvO2 and O2ER in static heart group were lower than those in beating heart group (P<0. 01). During rewarming stages, SjO2 in static heart group was lower than this in beating heart group (P<0. 05), Da-jvO2 and O2ER in static heart group were higher than those in beating heart group (P<0. 05). Conclusion The interference of mild hypothermic CPB for heating open heart surgery on cerebral oxygen metabolism is lighter.