Weinrich Malte, Scheingraber Stefan, Stephan Bernhard, Weiss Christel, Kayser Anna, Kopp Berit, Schilling Martin K
Department of General, Visceral and Vascular Surgery, Hospital Worms, Worms, Germany.
Clin Hemorheol Microcirc. 2008;39(1-4):409-15.
Measurement of central venous oxygen saturation has become a surrogate parameter for fluid administration, blood transfusions and treatment with catecholamines in (early) goal directed therapy in the treatment of acute septic patients. These strategies are not easily transferred to the postoperative management of abdominal surgery due to the different conditions in surgical patients.
A study population of 15 patients (8 females/7 males) underwent elective major abdominal surgery: 6 gastrectomies, 5 major liver resections and 4 lower anterior rectum resections. Surgery was performed for primary or secondary malignancy. The patients' age was 65.4+/-12.7 (mean+/-standard deviation, range 44-84, median 62) years. Blood samples were taken intraoperatively from indwelling central venous lines as well as from draining veins at the surgical site. Blood gas analyses to determine the oxygen saturations were performed immediately. All patients were operated in standardized general anesthesia including epidural analgesia and in a balanced volume status.
Central venous oxygen saturations and oxygen saturations in blood from the draining veins of the surgical site showed a wide range with high intra- and interindividual differences intraoperatively. Overall, at most time points no correlation between the two oxygen saturations could be detected in three operation types. A significant correlation was only observed at one time point during liver resections.
Our results show a lack of correlation between central venous oxygen saturations and oxygen saturations in the draining veins of the surgical site during major abdominal surgery. Measurement of central venous oxygen saturations does not seem to be a good surrogate for the local oxygen supply in the field of interest in major abdominal surgery even under standardized conditions.
在急性脓毒症患者的（早期）目标导向治疗中，中心静脉血氧饱和度的测量已成为指导液体输注、输血及使用儿茶酚胺治疗的替代参数。由于外科患者的情况不同，这些策略不易应用于腹部手术的术后管理。
15例患者（8例女性/7例男性）接受了择期腹部大手术：6例胃切除术、5例肝大部切除术和4例低位前直肠切除术。手术目的是治疗原发性或继发性恶性肿瘤。患者年龄为65.4±12.7（均值±标准差，范围44 - 84岁，中位数62岁）。术中从留置的中心静脉导管以及手术部位的引流静脉采集血样。立即进行血气分析以测定血氧饱和度。所有患者均在包括硬膜外镇痛的标准化全身麻醉下手术，且处于容量平衡状态。
术中中心静脉血氧饱和度和手术部位引流静脉血的血氧饱和度范围较宽，个体内和个体间差异较大。总体而言，在三种手术类型的大多数时间点，未检测到两种血氧饱和度之间存在相关性。仅在肝切除术中的一个时间点观察到显著相关性。
我们的结果表明，在腹部大手术期间，中心静脉血氧饱和度与手术部位引流静脉血的血氧饱和度之间缺乏相关性。即使在标准化条件下，测量中心静脉血氧饱和度似乎也不是腹部大手术感兴趣区域局部氧供的良好替代指标。
