CAJ | 학술논문

目的观察体外循环（CPB）冠脉搭桥（CABG）手术期脑氧供需平衡变化，并与双瓣置换（DVR）手术患者进行比较。方法 CABG和DVR患者各30例，取右颈内静脉球部和桡动脉血进行血气分析及乳酸测定，并计算动脉-颈内静脉血氧含量差（Ca-jO2）、脑乳酸产量（ADVL）、脑氧摄取率（OER）和乳酸-氧指数（LOI）。结果 ①CPB开始前上述指标变化不明显，CPB低温期间颈内静脉氧饱和度（SjO2）和氧分压（PjO2）明显升高，复温期间下降，但与麻醉前比无差异，各观察时间点两组间差异无显著性。②手术开始后，动脉和静脉血乳酸均渐增加，ADVL变化不明显，但在低温和复温时，CDBG组的ADVL和LOI高于DVR组。结论两组患者CPB期间可基本维持全脑氧供需平衡，而CABG组ADVL和LOI高于DVR组，是否存在局灶性脑氧供需失衡有待进一步研究。
목적 관찰체외순배（CPB）관맥탑교（CABG）수술기뇌양공수평형변화，병여쌍판치환（DVR）수술환자진행비교。방법 CABG화DVR환자각30례，취우경내정맥구부화뇨동맥혈진행혈기분석급유산측정，병계산동맥-경내정맥혈양함량차（Ca-jO2）、뇌유산산량（ADVL）、뇌양섭취솔（OER）화유산-양지수（LOI）。결과 ①CPB개시전상술지표변화불명현，CPB저온기간경내정맥양포화도（SjO2）화양분압（PjO2）명현승고，복온기간하강，단여마취전비무차이，각관찰시간점량조간차이무현저성。②수술개시후，동맥화정맥혈유산균점증가，ADVL변화불명현，단재저온화복온시，CDBG조적ADVL화LOI고우DVR조。결론 량조환자CPB기간가기본유지전뇌양공수평형，이CABG조ADVL화LOI고우DVR조，시부존재국조성뇌양공수실형유대진일보연구。
Objective To observe the perioperative changes of cerebral oxygenbalance in patients undergoing coronary artery bypass grafting（CABG）compared with double vales replacement（DVR）．Methods Blood gas analysis and lactate concentration in arterial and jugular bulb blood were monitored during operation，from which the arteriojugular venous oxygen content difference（Ca-jO2），cerebral lactate production（ADVL） cerebral oxygen extraction ratio（OER），and lactatr-oxygen index（LOI）were calculated in patients with CABG and DVR（30 patients in each group）．Results ①Parameters mentioned above had no significant changes before initiation of CPB．Jugular venous oxygen saturation（SjO2）and oxygen partial pressure（PjO2） significantly increased during hypothermia and significantly decreased during rewarming，but no statistical differences compared with the levels before anesthesia．②Arterial and jugular venous blood lactate increased gradually after the surgery began，but ADVL did not change significantly．ADVL and LOI were higher in CABG group than those in DVR group ．Conclusion Total cerebral oxygen balance are maintained in two groups during CPB．Whether the local cerebral oxygen unbalance exists in CABG group needs further study．