Biagioli B, Rossi C, Giomarelli P P, Pescatori G, Barbini P, Grossi A
G Ital Cardiol. 1981;11(9):1288-300.
We studied 64 patients who underwent cardiac surgery. Hemodynamic and metabolic variables-cardiac index (CI), total peripheral resistances (TSR), oxygen consumption and (VO2), urinary output, alveolar-arterial oxygen difference (delta A-a O2) - were related with oxygenator (bubble or membrane oxygenator) and with treatment (with or without methylprednisolone). 31 patients were perfused with membrane oxygenator (MO), 33 with bubble oxygenator (BO), 13 patients MO and 18 patients, BO were treated with methylprednisolone (mps). The analyzed variables were sampled 15 minutes after the start and one to five times during the perfusion. At first data were analyzed in terms of mean values in whole set of time intervals. Only delta A-a O2 showed statistically significant difference between the MO and the BO group (282 +/- 110 versus 361 +/- 82, p less than 0.005). Between nomps-treated and mps-treated patients statistically significant difference were found in TSR (2.134 +/- 362 versus 1.785 +/- 317, p less than 0.005) and in delta A-a O2 (293 +/- 92 versus 355 +/- 108, p less than 0.02). Secondo analysis is concerning time change of variables. The time behaviour of TSR is similar in all groups studied, but a statistically significant lower value was found in mps-treated patients in every time interval. The VO2, in the last time interval, is statistically higher in the mps-treated than in the nomps-treated patients (p less than 0.05) and furthermore, for the same temperature change, the rise of VO2 is higher in the mps-treated (p less than 0.001). The delta A-a O2 shows time increase both in the MO and in the BO group, but the MO patients start from statistically significant lower values than the BO and the behaviours remain parallel for all analyzed time. The results are interpreted and discussed in relation to hemodynamic and metabolic patterns of perfusion as good or bad tissue perfusion.
我们研究了64例接受心脏手术的患者。血流动力学和代谢变量——心脏指数(CI)、总外周阻力(TSR)、氧耗量(VO2)、尿量、肺泡-动脉血氧分压差(delta A-a O2)——与氧合器(鼓泡式或膜式氧合器)以及治疗方式(使用或不使用甲泼尼龙)相关。31例患者使用膜式氧合器(MO)进行灌注,33例使用鼓泡式氧合器(BO),13例使用MO的患者和18例使用BO的患者接受了甲泼尼龙(mps)治疗。在开始后15分钟以及灌注期间一至五次对分析变量进行采样。首先,根据整个时间间隔的平均值对数据进行分析。仅delta A-a O2在MO组和BO组之间显示出统计学上的显著差异(282±110对361±82,p<0.005)。在未接受mps治疗和接受mps治疗的患者之间,TSR(2.134±362对1.785±317,p<0.005)和delta A-a O2(293±92对355±108,p<0.02)存在统计学上的显著差异。二次分析涉及变量随时间的变化。在所有研究组中,TSR随时间的变化情况相似,但在每个时间间隔内,接受mps治疗的患者TSR值在统计学上显著更低。在最后一个时间间隔内,接受mps治疗的患者VO2在统计学上高于未接受mps治疗的患者(p<0.05),此外,对于相同的温度变化,接受mps治疗的患者VO2的升高幅度更大(p<0.001)。delta A-a O2在MO组和BO组中均随时间增加,但MO组患者起始值在统计学上低于BO组,并且在所有分析时间内二者变化趋势保持平行。结合灌注的血流动力学和代谢模式,即良好或不良的组织灌注,对结果进行了解释和讨论。