Utoh J, Moriyama S, Kitamura N, Okamoto K
First Department of Surgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-0811.
Ann Thorac Cardiovasc Surg. 1999 Feb;5(1):27-30.
Arterial-venous carbon dioxide tension differences (Pv-aCO2) are known to increase during the resuscitation phase following several types of shock. We hypothesized that Pv-aCO2 increases immediately following hypothermic cardiopulmonary bypass (CPB) because of the metabolic impairments that occur during CPB. Fifty-six adult patients underwent hypothermic CPB for cardiac surgery. Arterial and mixed venous blood gases were analyzed every 6 hours for the first 24 hours following cardiac surgery. Immediately after surgery, the Pv-aCO2 was elevated (8.2 +/- 2.9 mmHg), but gradually returned to a normal range within 12 hours (6.2 +/- 3.2 mmHg, p < 0.001). Factors (X) which correlated significantly with the postoperative Pv-aCO2 (Y) included the minimum rectal temperature during CPB (Y= 27.3 - 0.664X, p = 0.011) and the duration of CPB (Y= 5.6 + 0.0172X, p = 0.047). The abnormally high Pv-aCO2 during the early postoperative period may be caused by metabolic impairments during hypothermic CPB. The recovery stage following open heart surgery is therefore similar to the resuscitation phase after shock.
众所周知，在几种类型的休克复苏阶段，动静脉二氧化碳分压差值（Pv-aCO2）会增加。我们推测，低温体外循环（CPB）后Pv-aCO2会立即升高，这是由于CPB期间发生的代谢损伤所致。56例成年患者接受了心脏手术的低温CPB。心脏手术后的头24小时内，每6小时分析一次动脉血和混合静脉血气。术后即刻，Pv-aCO2升高（8.2±2.9 mmHg），但在12小时内逐渐恢复到正常范围（6.2±3.2 mmHg，p<0.001）。与术后Pv-aCO2（Y）显著相关的因素（X）包括CPB期间的最低直肠温度（Y=27.3 - 0.664X，p = 0.011）和CPB持续时间（Y=5.6 + 0.0172X，p = 0.047）。术后早期Pv-aCO2异常升高可能是由于低温CPB期间的代谢损伤所致。因此，心脏直视手术后的恢复阶段类似于休克后的复苏阶段。
