摘要
目的:分析体外循环(CPB)心脏手术后静-动脉血二氧化碳分压差(Pv-aCO2)/动-静脉血氧含量差(Ca-vO2)比值与乳酸清除的关系,评估Pv-aCO2/Ca-vO2在CPB心脏手术后指导乳酸清除治疗的价值.方法:选择CPB心脏术后病人119例,术后转入ICU时和术后3 h分别送检中心静脉、动脉血气分析,计算相应Pv-aCO2/Ca-vO2比值.收集病人一般资料、血流动力学指标、氧代谢指标、乳酸、外周灌注指数(PI)、脉压差变异率(PPV)、序贯器官衰竭评分(SOFA)、血管活性药物剂量等相关数据,计算3 h乳酸清除率(LCR),并根据3 h LCR,将病人分为LCR<10％组21例和LCR≥10％组98例,比较2组病人血流动力学指标、氧代谢指标、PI、PPV和Pv-aCO2/Ca-vO2等.结果:2组病人性别、体温、SOFA评分、PH、PI、PPV、血红蛋白、去甲肾上腺素、肾上腺素剂量及血流动力学参数差异均无统计学意义(P>0.05).术后入ICU即刻,LCR≥10％组Pv-aCO2/Ca-vO2低于LCR<10％组(P<0.05);术后3 h,LCR≥10％组动脉血乳酸明显低于LCR<10％组(P<0.01).结论:CPB心脏手术后,Pv-aCO2/Ca-vO2可用于辅助指导病人术后乳酸清除,较低的Pv-aCO2/Ca-vO2有利于术后乳酸清除.
Abstract
Objective:To analyze the relationship between the ratio of difference of venous-arterial blood carbon dioxide differential pressure( Pv-aCO2 ) to difference of arterial-venous blood oxygen content ( Ca-vO2 ) ( Pv-aCO2/Ca-vO2 ) and lactic acid clearance in cardiac surgery patients after cardiopulmonary bypass,and evaluate its therapy value.Methods:A total of 119 CPB post-cardiac patients were selected,the central vein and arterial blood gas analysis at the time of transferring to ICU and after 3 h of surgery were detected,and the corresponding Pv-aCO2/Ca-vO2 ratio was calculated.The general conditions,hemodynamic indexes,oxygen metabolism indexes,lactic acid,peripheral perfusion index( PI),SOFA score and vasoactive drug dose were collected to calculate the 3 h lactate clearance rate(LCR).According to the 3 h LCR,the patients were divided into the LCR<10％ group(21 cases) and LCR≥10％ group(98 cases) .The hemodynamic indexes,oxygen metabolism indexes,PI,PPV and Pv-aCO2/Ca-vO2 were compared between two groups.Results:There was no statistical significance in the gender,body temperature,SOFA score,PH,PI,PPV,hemoglobin,norepinephrine,epinephrine dose and hemodynamic parameters between two groups(P>0.05).At the time of transferring to ICU,the Pv-aCO2/Ca-vO2 in the LCR≥10％ group was lower than that in LCR<10％(P<0.05).After 3 h of surgery,the lactic acid in the LCR≥10％ group was significantly lower than that in LCR<10％(P<0.01).Conclusions:After CPB cardiac surgery,the Pv-aCO2/Ca-vO2 can be used to assist the guidance of postoperative lactic acid clearance,and the lower level of Pv-aCO2/Ca-vO2 is conducive to postoperative lactic acid clearance.
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