体外循环后正性肌力支持治疗与中心静脉-动脉血二氧化碳分压之间的关系。
The relationship between inotropic support therapy and central partial pressure of venous-arterial carbon dioxide after cardiopulmonary bypass.
作者信息
Erenler Ferhat, Yapıcı Nihan, Kudsioğlu Türkan, Atalan Nazan, Acarel Murat, Orhan Gökçen, Kavaklı Ali Sait, Aykaç Zuhal
机构信息
Department of Anaesthesiology and Reanimation, Demiroğlu Bilim University, Şişli Florence Nightingale Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
出版信息
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Apr 24;27(2):165-172. doi: 10.5606/tgkdc.dergisi.2019.16851. eCollection 2019 Apr.
BACKGROUND
This study aims to investigate the effects of partial pressure of venous-arterial carbon dioxide changes in the early period after cardiopulmonary bypass in patients who did or did not receive inotropic support therapy and the effect of these changes on tissue perfusion.
METHODS
A total of 100 consecutive patients (70 males, 30 females; mean age 61.8±2.3 years; range, 20 to 75 years) who underwent open heart surgery were divided into two groups as those who did not receive any inotropic agent (group 1, n=50) and those who received at least one inotropic agent (group 2, n=50) during the early postoperative period. Heart rate, blood oxygen saturation level, mean arterial pressure, central venous pressure and urine volume, lactate and base excess levels were recorded during the postoperative first 24 hours. At the same timeframe, partial pressure of venous-arterial carbon dioxide level was calculated from central venous and peripheral blood samples.
RESULTS
In both groups, partial pressure of venous-arterial carbon dioxide were significantly higher in the postoperative fourth hour compared with basal values. This significant difference continued for the postoperative first 24 hours. Partial pressure of venous-arterial carbon dioxide in group 2 was significantly higher at the 12-hour measurement (p=0.002). Lactate levels at zeroth and eighth hours were significantly higher in group 2 (p=0.012 and p=0.017, respectively). Fourthhour urine excretion volumes were significantly lower in group 1 (p=0.010). Mean arterial pressure at zeroth, 12th and 20th hours was significantly higher in group 2 (p=0.001, p=0.016, and p=0.027, respectively). At the eighth-hour measurement, a positive weak relationship was detected between partial pressure of venousarterial carbon dioxide and lactate levels (r=0.253 and p=0.033).
CONCLUSION
This study demonstrated that partial pressure of venous-arterial carbon dioxide increased in the first few hours and remained to be high for 24 hours after cardiopulmonary bypass independently of the use of inotropic support. However, in the postoperative period, even after lactate and base excess levels return to baseline values, partial pressure of venous-arterial carbon dioxide may continue to remain at high values, which may indicate impaired perfusion in some tissues.
背景
本研究旨在调查接受或未接受正性肌力支持治疗的患者在体外循环术后早期静脉 - 动脉二氧化碳分压变化的影响以及这些变化对组织灌注的影响。
方法
总共100例连续接受心脏直视手术的患者（70例男性，30例女性；平均年龄61.8±2.3岁；范围20至75岁）被分为两组，一组为术后早期未接受任何正性肌力药物的患者（第1组，n = 50），另一组为接受至少一种正性肌力药物的患者（第2组，n = 50）。记录术后头24小时内的心率、血氧饱和度水平、平均动脉压、中心静脉压和尿量、乳酸和碱剩余水平。在同一时间段内，根据中心静脉血和外周血样本计算静脉 - 动脉二氧化碳分压水平。
结果
两组患者术后第4小时的静脉 - 动脉二氧化碳分压均显著高于基础值。这种显著差异在术后头24小时持续存在。第2组在12小时测量时静脉 - 动脉二氧化碳分压显著更高（p = 0.002）。第2组在第0小时和第8小时的乳酸水平显著更高（分别为p = 0.012和p = 0.017）。第1组第4小时的尿量显著更低（p = 0.010）。第2组在第0小时、第12小时和第20小时的平均动脉压显著更高（分别为p = 0.001、p = 0.016和p = 0.027）。在第8小时测量时，检测到静脉 - 动脉二氧化碳分压与乳酸水平之间存在微弱的正相关关系（r = 0.253，p = 0.033）。
结论
本研究表明，体外循环后最初几个小时静脉 - 动脉二氧化碳分压升高，且与是否使用正性肌力支持无关，在术后24小时内一直保持较高水平。然而，在术后期间，即使乳酸和碱剩余水平恢复到基线值后，静脉 - 动脉二氧化碳分压可能仍持续保持在较高水平，这可能表明某些组织灌注受损。
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