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体外循环期间的动脉血气管理

Arterial blood gas management during cardiopulmonary bypass.

作者信息

Sanjay O P, Devnath Anitha, Thejas B C

机构信息

Department of Anesthesiology, St. John's Medical College Hospital, 560034 Bangalore, Karnataka India.

出版信息

Indian J Clin Biochem. 2005 Jan;20(1):98-102. doi: 10.1007/BF02893051.

Abstract

This study sought to investigate the effects of α-stat and pH stat regimens on cardiac outcome during moderate hypothermic cardiopulmonary bypass. 100 patients undergoing elective coronary artery bypass grafting (CABG) were randomly assigned with respect to the target value for PaCO(2) during cardiopulmonary bypass (CPB) into 2 groups. In 50 patients the target PaCO(2) was 40 mmHg, measured at a standard electrode temperature of 37°C while in the other 50 patients the target PaCO(2) was 40 mmHg, corrected to the patients nasopharyngeal temperature (lowest value reached: 32±0.5°C). There were no significant differences between groups with regards to cardiac outcome such as appearance of new 'Q' waves on the electrocardiogram, postoperative creatinine kinase-MB fraction, systemic vascular resistance (SVR), cardiac index (Cl), need for inotropic or intra-aortic balloon pump support and the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO(2) management during CPB at moderate hypothermia has no clinically significant effect on cardiac outcome.

摘要

本研究旨在探讨α-稳态和pH稳态方案对中度低温体外循环期间心脏结局的影响。100例行择期冠状动脉旁路移植术(CABG)的患者,根据体外循环(CPB)期间PaCO₂的目标值随机分为2组。50例患者的目标PaCO₂为40 mmHg,在标准电极温度37°C下测量,而另外50例患者的目标PaCO₂为40 mmHg,并校正为患者的鼻咽温度(最低值:32±0.5°C)。两组在心脏结局方面无显著差异,如心电图上新“Q”波的出现、术后肌酸激酶-MB同工酶、全身血管阻力(SVR)、心脏指数(Cl)、是否需要使用正性肌力药物或主动脉内球囊泵支持以及术后通气时间或重症监护病房住院时间。这些发现支持以下假设:中度低温CPB期间的CO₂管理对心脏结局无临床显著影响。

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