CAJ | 학술논문

目的探讨经过术后上腔静脉血氧饱和度(central venous oxygen saturation,ScvO2)＞70％的冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者是否能够应用静动脉二氧化碳分压差(central venous atrial carbon dioxide partial pressure,Pcv-aCO2)作为围术期心输出量评估指标. 方法 142例术后早期ScvO2＞70％的CABG患者,根据术后即刻Pcv-aCO2是否≥6 mm Hg(1 mm Hg=0.133 kPa),分为高Pcv-aCO2组和低Pcv-aCO2组.观察2组患者在术后即刻(T0)、8(T8)、12(T12)、24(T24)、48 h(T48)时的血流动力学指标,灌注指标,心功能状态,恢复情况. 结果 64例患者为高Pcv-aCO2组,余78例患者为低Pcv-aCO2组.两组患者入组时低Pcv-aCO2组动脉血乳酸(lactate,Lac)、心指数(cardiac index,CI)、血管活性药物评分分别为(3.7±1.3) mmol/L、(3.54±0.88) L/m2、(9±5),高Pcv-aCO2组Lac、CI、血管活性药物评分分别为(6.5±2.5) mmol/L、(2.79±0.68) L/m2、(13±6),两组比较差异有统计学意义(P＜0.05).两组患者入组后均在术后8h出现CI下降,Lac及血管活性药物评分上升,低Pcv-aCO2组在T12、T24、T48时CI逐渐上升,Lac及血管活性药物评分下降；高Pcv-aCO2组在T24时才出现CI逐渐上升,Lac及血管活性药物评分下降,低Pcv-aCO2组CI明显高于高Pcv-aCO2组(P＜0.05)；低Pcv-aCO2组Lac、血管活性药物评分下降时间早于高Pcv-aCO2组(P＜0.05).低Pcv-aCO2组主动脉内球囊反搏(intra-aortic balloon pump,IABP)应用率为3.8％、呼吸机辅助时间为(34±22)h、住重症监护室(ICU)时间为(106±26)h、呼吸衰竭发生率5.1％、肾功能衰竭发生率1.3％,高Pcv-aCO2组IABP应用率为12.5％、呼吸机辅助时间为(48±27)h、住ICU时间为(136-45)h、呼吸衰竭发生率17.2％、肾功能衰竭发生率1.3％,两组比较差异有统计学意义(P＜0.05). 结论 CABG患者术后早期Pcv-aCO2≥6mmHg提示心输出量不足,术后并发症的发生与早期高Pcv-aCO2水平有明显关系. 目的探討經過術後上腔靜脈血氧飽和度(central venous oxygen saturation,ScvO2)＞70％的冠狀動脈徬路移植術(coronary artery bypass grafting,CABG)患者是否能夠應用靜動脈二氧化碳分壓差(central venous atrial carbon dioxide partial pressure,Pcv-aCO2)作為圍術期心輸齣量評估指標. 方法 142例術後早期ScvO2＞70％的CABG患者,根據術後即刻Pcv-aCO2是否≥6 mm Hg(1 mm Hg=0.133 kPa),分為高Pcv-aCO2組和低Pcv-aCO2組.觀察2組患者在術後即刻(T0)、8(T8)、12(T12)、24(T24)、48 h(T48)時的血流動力學指標,灌註指標,心功能狀態,恢複情況. 結果 64例患者為高Pcv-aCO2組,餘78例患者為低Pcv-aCO2組.兩組患者入組時低Pcv-aCO2組動脈血乳痠(lactate,Lac)、心指數(cardiac index,CI)、血管活性藥物評分分彆為(3.7±1.3) mmol/L、(3.54±0.88) L/m2、(9±5),高Pcv-aCO2組Lac、CI、血管活性藥物評分分彆為(6.5±2.5) mmol/L、(2.79±0.68) L/m2、(13±6),兩組比較差異有統計學意義(P＜0.05).兩組患者入組後均在術後8h齣現CI下降,Lac及血管活性藥物評分上升,低Pcv-aCO2組在T12、T24、T48時CI逐漸上升,Lac及血管活性藥物評分下降；高Pcv-aCO2組在T24時纔齣現CI逐漸上升,Lac及血管活性藥物評分下降,低Pcv-aCO2組CI明顯高于高Pcv-aCO2組(P＜0.05)；低Pcv-aCO2組Lac、血管活性藥物評分下降時間早于高Pcv-aCO2組(P＜0.05).低Pcv-aCO2組主動脈內毬囊反搏(intra-aortic balloon pump,IABP)應用率為3.8％、呼吸機輔助時間為(34±22)h、住重癥鑑護室(ICU)時間為(106±26)h、呼吸衰竭髮生率5.1％、腎功能衰竭髮生率1.3％,高Pcv-aCO2組IABP應用率為12.5％、呼吸機輔助時間為(48±27)h、住ICU時間為(136-45)h、呼吸衰竭髮生率17.2％、腎功能衰竭髮生率1.3％,兩組比較差異有統計學意義(P＜0.05). 結論 CABG患者術後早期Pcv-aCO2≥6mmHg提示心輸齣量不足,術後併髮癥的髮生與早期高Pcv-aCO2水平有明顯關繫.
목적 탐토경과술후상강정맥혈양포화도(central venous oxygen saturation,ScvO2)＞70％적관상동맥방로이식술(coronary artery bypass grafting,CABG)환자시부능구응용정동맥이양화탄분압차(central venous atrial carbon dioxide partial pressure,Pcv-aCO2)작위위술기심수출량평고지표. 방법 142례술후조기ScvO2＞70％적CABG환자,근거술후즉각Pcv-aCO2시부≥6 mm Hg(1 mm Hg=0.133 kPa),분위고Pcv-aCO2조화저Pcv-aCO2조.관찰2조환자재술후즉각(T0)、8(T8)、12(T12)、24(T24)、48 h(T48)시적혈류동역학지표,관주지표,심공능상태,회복정황. 결과 64례환자위고Pcv-aCO2조,여78례환자위저Pcv-aCO2조.량조환자입조시저Pcv-aCO2조동맥혈유산(lactate,Lac)、심지수(cardiac index,CI)、혈관활성약물평분분별위(3.7±1.3) mmol/L、(3.54±0.88) L/m2、(9±5),고Pcv-aCO2조Lac、CI、혈관활성약물평분분별위(6.5±2.5) mmol/L、(2.79±0.68) L/m2、(13±6),량조비교차이유통계학의의(P＜0.05).량조환자입조후균재술후8h출현CI하강,Lac급혈관활성약물평분상승,저Pcv-aCO2조재T12、T24、T48시CI축점상승,Lac급혈관활성약물평분하강；고Pcv-aCO2조재T24시재출현CI축점상승,Lac급혈관활성약물평분하강,저Pcv-aCO2조CI명현고우고Pcv-aCO2조(P＜0.05)；저Pcv-aCO2조Lac、혈관활성약물평분하강시간조우고Pcv-aCO2조(P＜0.05).저Pcv-aCO2조주동맥내구낭반박(intra-aortic balloon pump,IABP)응용솔위3.8％、호흡궤보조시간위(34±22)h、주중증감호실(ICU)시간위(106±26)h、호흡쇠갈발생솔5.1％、신공능쇠갈발생솔1.3％,고Pcv-aCO2조IABP응용솔위12.5％、호흡궤보조시간위(48±27)h、주ICU시간위(136-45)h、호흡쇠갈발생솔17.2％、신공능쇠갈발생솔1.3％,량조비교차이유통계학의의(P＜0.05). 결론 CABG환자술후조기Pcv-aCO2≥6mmHg제시심수출량불족,술후병발증적발생여조기고Pcv-aCO2수평유명현관계.
Objective To investigate the central venous atrial carbon dioxide partial pressure (Pcv-aCO2),as a effective index,perioperatively predicting cardiac out-put for the patients undergoing coronary artery bypass grafting (CABG) with central venous oxygen saturation(ScvO2)＞70％.Methods 142 patients underwent CABG suffering early ScvO2＞70％ were divided into two groups by immediate Pcv-aCO2 (threshold of 6 mm Hg)(1 mm Hg=0.133 kPa).All parameters,including hemodynamic,perfusion index,cardiac status,recovery situation were observed and collected postoperatively from the high Pcv-aCO2 group (64 cases) and low Pcv-aCO2 group(78 cases) at the very point of 0(T0),8(T8),12(T12),24(T24),48 h(T48).Results The parameters of the predictors such as arterial lactate (Lac),CI and vasoactive score were (3.7±1.3) mmol/L、(3.54±0.88) L/m2、(9±5) respectively in the low Pcv-aCO2 group,while the figures were (6.5±2.5) mmol/L、(2.79±0.68) L/m2、(13±6) correspondingly in the high Pcv-aCO2 group,with an obviously different comparison between the two group (P＜O.05),which in details showed that both groups shared similar trend of CI decline,Lac score soaring and the vasoactive drug application increase at the first 8 h postoperatively,and CI increased,the Lac and the vasoactive reduced on the postoperative hour T12,T24,T48 in the low Pcv-aCO2 group,while the tendency was turned up on the postoperative hour T24 in the high Pcv-aCO2 group.Concluding comparison showed that CI in low Pcv-aCO2 group was significantly higher than the high Pcv-aCO2 group (P＜0.05),while Lac and vasoactive drug administration in the former group decreased rapidly compared with the latter.Besides,the low Pcv-aCO2 group showed great advantages in the indexes including the application rate of IABP(3.8％),mechanical ventilation time(34±22) h,ICU stay length(106±26) h,postoperative respiratory failure incidence (5.1％) and the renal failures incidence (1.3％),while the parameters was obviously higher in the high Pcv-aCO2 group,which were 12.5％,(48±27),(136±45) h,17.2％ and 1.3％ respectively (P＜0.05).Conclusions Early Pcv-aCO2≥6 mm Hg,as a poor outcome predictor,suggested insufficiently effective circulating blood flow,thus there was significant relevance between the occurrence of postoperative complications and early high level of Pcv-aCO2.