重症先天性心脏病手术期间氧供量和氧耗量的变化

Changes of perioperative oxygen supply and consumption in 32 patients with severe congenital cardiac disease

目的了解重症先天性心脏病手术期间的氧合状态。方法测定了32例心脏复跳后连续应用多巴酚丁胺或米力农情况下体外循环中、停体外循环后30min、手术结束、术后2h、术后16h等时点的心脏指数(CI)、氧供量(DO2)、氧耗量(VO2)和氧摄取率(ERO2)。结果①体外循环中和体外循环结束DO2和VO2有高度正相关性(P<0.01),相关系数分别为0.861,0.811;②体外循环中与体外循环后30min各数据比较CI、DO2、VO2前者明显低于后者(P<0.05或0.01),ERO2无显著性差异;③体外循环结束后各点数据比较,CI能维持在3L/(min·m2)以上,DO2能维持在550ml/(min·m2)以上。VO2能维持在120ml/(min·m2)以上。结论重症先天性心脏病手术期间存在病理性氧供依赖。心脏复跳后应用多巴酚丁胺能改善组织对氧的摄取和利用。体外循环后连续应用多巴酚丁胺或米力农很难进行DO2、VO2、CI的超正常值维护,但CI不小于3L/(min·m2)。手术后16h循环功能尚未完全恢复,仍需继续加强正性肌力药的治疗。

Objective To study the changes of oxygen metabolism of the patients with severe con-genital cardiac disease. Methods Dobutamine or Milinone was used continously on 32 patients after aortic crossclamp being removed. Cardiac index (CI), oxygen supply (DO2), oxygen consumption (VO2), oxygen extract rate (ERO2) were examined in different period of perioperation. Results ①There was a positive correlation between the DO2 and VO2 during CPB(r=0.861, P<0.01) and after CPB(r=0.811,P<0.01);②CI,DO2,VO2 during CPB were lower than those at 30 min after CBP (P<0.01 or 0.01). There was no significant difference in ERO2;③All the above date after CBP maintained at follow levelsr CI, 3L/(min·m2);DO2,550ml/(min·m2);VO2,120ml/(min·m2). Conclusions There is pathological oxygen supply dependance in the patients with several congenital cardiac disease. The absorbing and utilization of oxygen by the organ can be improved by using dobutamine after the removement of the heart. At 16th hours after the operation, the circullation function can not be turned to the normal level, more attention should be paied to the useage of cardiotonic agents.