Opper S E, Fibuch E E, Nelson R E, Lonergan J H
Department of Anesthesiology, St Luke's Hospital Kansas City, MO 64111.
J Cardiothorac Vasc Anesth. 1992 Feb;6(1):46-50. doi: 10.1016/1053-0770(91)90044-t.
Changes in pre-bypass and post-bypass P(a-ET)CO2 gradients were evaluated regarding the type of bypass flow (pulsatile or nonpulsatile) and oxygenator (membrane or bubble). Duration of bypass and hemodynamic changes were analyzed also to determine their possible influence on PaCO2, PETCO2, and P(a-ET)CO2. A total of 36 adult patients undergoing cardiopulmonary bypass were anesthetized using a sufentanil-pancuronium-oxygen technique. Patients were divided into three groups based on the type of oxygenator and pump flow: group 1 (control group) consisted of a bubble oxygenator with nonpulsatile flow (BN), group 2 consisted of a bubble oxygenator with pulsatile flow (BP), and group 3 consisted of a membrane oxygenator with nonpulsatile flow (MN). Cardiac parameters (MAP, CI, SVR, and PVR) PaCO2, PETCO2, and P(a-ET)CO2 were determined pre-bypass and post-bypass following steady-state conditions. For the entire group there was a trend for the P(a-ET)CO2 gradient to increase in the post-bypass period (pre-bypass = 3.5 +/- 0.5 mm Hg, post-bypass = 4.3 +/- 0.5 mm Hg.). However, this increase was not statistically significant. Pulsatile flow (group 2) demonstrated a significant correlation with the change in P(a-ET)CO2 gradients from the pre-bypass to the post-bypass period (r = 0.85) when compared with the other two groups (group 1: r = -0.09 and group 3: r = 0.37). Thus, the P(a-ET)CO2 gradient tended to remain constant from the pre-bypass to the post-bypass period in group 2, whereas it increased in groups 1 and 3. Changes in MAP, CI, SVR, and PVR and the duration of CPB did not influence the P(a-ET)CO2 gradient.
就体外循环血流类型（搏动性或非搏动性）和氧合器类型（膜式或鼓泡式）对体外循环前和体外循环后P（a - ET）CO₂梯度的变化进行了评估。还分析了体外循环持续时间和血流动力学变化，以确定它们对动脉血二氧化碳分压（PaCO₂）、呼气末二氧化碳分压（PETCO₂）和P（a - ET）CO₂的可能影响。总共36例接受体外循环的成年患者采用舒芬太尼 - 潘库溴铵 - 氧气技术进行麻醉。根据氧合器类型和泵流量将患者分为三组：第1组（对照组）由采用非搏动性血流的鼓泡式氧合器（BN）组成，第2组由采用搏动性血流的鼓泡式氧合器（BP）组成，第3组由采用非搏动性血流的膜式氧合器（MN）组成。在达到稳态条件后，于体外循环前和体外循环后测定心脏参数（平均动脉压（MAP）、心脏指数（CI）、体循环血管阻力（SVR）和肺血管阻力（PVR））、PaCO₂、PETCO₂和P（a - ET）CO₂。对于整个组，体外循环后阶段P（a - ET）CO₂梯度有增加的趋势（体外循环前 = 3.5±0.5 mmHg，体外循环后 = 4.3±0.5 mmHg）。然而，这种增加没有统计学意义。与其他两组（第1组：r = -0.09和第3组：r = 0.37）相比，搏动性血流（第2组）显示从体外循环前到体外循环后阶段P（a - ET）CO₂梯度变化具有显著相关性（r = 0.85）。因此，第2组从体外循环前到体外循环后阶段P（a - ET）CO₂梯度趋于保持恒定，而第1组和第3组则增加。MAP、CI、SVR和PVR的变化以及体外循环持续时间均未影响P（a - ET）CO₂梯度。
