CAJ | 학술논문

目的对比研究幼儿期先天性心脏病(先心病)心脏直视术后心脏功能与氧代谢的变化规律.方法回顾性研究2006年1月至2009年1月,北京安贞医院小儿心脏科幼儿期先心病患儿55例,其中男34例,女21例.分为2组:简单组30例,包括单纯室间隔缺损(室缺)15例 ;室缺+房间隔缺损(房缺)9例 ;室缺+房缺+动脉导管未闭6例,均合并肺动脉高压.复杂组25例,包括法洛四联症12例,肺动脉狭窄型右室双出口8例,完全型肺静脉异位引流心上型5例.均在静吸复合麻醉中低温体外循环辅助下完成心脏直视手术.分别于手术完成后即刻(术后0h)、术后4、8、12、24、48、72 h时热稀释法测定心排血量(CO).经桡动脉及漂浮导管顶端抽取血标本行血气分析.计算心排血量指数(CI),氧供应指数(DO2I)、氧消耗指数(VO2I)、氧摄取率(O2ER).同时记录中心温度、动脉血乳酸、混合静脉血氧饱和度(ScVO2)及正性肌力药物用量.对比分析两组间心脏功能与氧代谢的变化规律.结果 (1)术后8h时ScVO2两组患儿最低(简单组68％±14％ ;复杂组65％±9％) ;术后12h时CI(L·min-1·m-2)两组患儿最低(简单组3.29±0.65;复杂组2.88 ±0.54) ;DO2I(ml·min-1·m-2)、VO2I(ml·min-1·m-2)复杂组最低(分别为492±153和138 ±45) ;(2)术后DO2I、VO2I、O2ER、ScVO2随CI变化而改变,简单组高于复杂组 ;(3)术后CI与DO2I、VO2I、ScVO2正相关,与O2ER负相关.结论先心病心脏直视术后心功能下降,氧代谢紊乱,术后12 h最重,复杂畸形更明显.术后早期积极提高心排量可以改善组织氧合.
목적 대비연구유인기선천성심장병(선심병)심장직시술후심장공능여양대사적변화규률.방법 회고성연구2006년1월지2009년1월,북경안정의원소인심장과유인기선심병환인55례,기중남34례,녀21례.분위2조:간단조30례,포괄단순실간격결손(실결)15례 ;실결+방간격결손(방결)9례 ;실결+방결+동맥도관미폐6례,균합병폐동맥고압.복잡조25례,포괄법락사련증12례,폐동맥협착형우실쌍출구8례,완전형폐정맥이위인류심상형5례.균재정흡복합마취중저온체외순배보조하완성심장직시수술.분별우수술완성후즉각(술후0h)、술후4、8、12、24、48、72 h시열희석법측정심배혈량(CO).경뇨동맥급표부도관정단추취혈표본행혈기분석.계산심배혈량지수(CI),양공응지수(DO2I)、양소모지수(VO2I)、양섭취솔(O2ER).동시기록중심온도、동맥혈유산、혼합정맥혈양포화도(ScVO2)급정성기력약물용량.대비분석량조간심장공능여양대사적변화규률.결과 (1)술후8h시ScVO2량조환인최저(간단조68％±14％ ;복잡조65％±9％) ;술후12h시CI(L·min-1·m-2)량조환인최저(간단조3.29±0.65;복잡조2.88 ±0.54) ;DO2I(ml·min-1·m-2)、VO2I(ml·min-1·m-2)복잡조최저(분별위492±153화138 ±45) ;(2)술후DO2I、VO2I、O2ER、ScVO2수CI변화이개변,간단조고우복잡조 ;(3)술후CI여DO2I、VO2I、ScVO2정상관,여O2ER부상관.결론 선심병심장직시술후심공능하강,양대사문란,술후12 h최중,복잡기형경명현.술후조기적겁제고심배량가이개선조직양합.
Objective To conduct a contrast study of postoperative cardiac output and oxygen metabolism in infants with congenital heart disease undergoing cardiopulmonary bypass.Methods Retrospective analysis was conducted for 55 case of congenital heart disease from January 2006 to January 2009 at our hospital.There were 34 males and 21 females.And they were divided into simple group (n =30) and complex group (n =25).In the simple group,all had pulmonary arterial hypertension and there were simple ventricular septal defect (VSD) (n =15),atrial septal defect (ASD) + VSD (n =9) and ASD + VSD + patent ductus arteriosus (PDA) (n =6) ; in the complex group,there were tetrology of Fallot (TOF) (n =12),double outlet of right ventricular with pulmonary stenosis (DORV) (n =8) and total anomalous pulmonary vein connection (TAPVC) (n =5).All completed cardiopulmonary bypass procedures under venous injection and inhalation anesthesia.Cardiac outputs were measured by the thermodilution method with a 4 F Swan-Ganz floating catheter at operation completion and postoperative 4,8,12,24,48,72 h.Arterial and mixed venous blood specimens were collected through radial artery and floating catheter for blood gas analysis.The parameters of cardiac index (CI),oxygen supply index (DO2I),oxygen consumption index (VO2I) and oxygen intake rate (O2ER) were calculated with PHLIPS M: 8007 A.Results (1) At postoperative 8 h,ScVO2 was minimal (simple group 68％ ± 14％ ; complex group 65％ ±9％) ; and postoperative 12 h CI (L · min-1 · m-2) bottomed out (simple group 3.29 ±0.65 ;complex group 2.88±0.54); DO2I(492 ± 153) ml · min-1 · m-2 and VO2I(138 ±45) ml · min-1 · m-2were minimal in complex group.(2) DO2I,VO2I,O2ER and ScVO2 changed with CI and simple group was higher than complex group.(3) Postoperative CI showed a positive correlation with DO2I,VO2I,ScVO2 and a negative correlation with O2ER.Conclusions The postoperative cardiac output decreases and oxygen metabolism becomes disordered in congenital heart disease.It is most obvious at postoperative 12 h.And complex CHD is more serious.Cardiac output should be actively boosted to improve tissue oxygen metabolism during an early postoperative period.