中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
8期
22-24
,共3页
乳酸%手术后并发症%中心静脉血氧饱和度%混合静脉血氧饱和度%氧利用率
乳痠%手術後併髮癥%中心靜脈血氧飽和度%混閤靜脈血氧飽和度%氧利用率
유산%수술후병발증%중심정맥혈양포화도%혼합정맥혈양포화도%양이용솔
Lactic acid%Postoperative complications%Central venous oxygen saturation%Mixed venous oxygen saturation%Oxygen extraction rate
目的 探讨心脏术后早期监测中心静脉血氧饱和度(ScvO2)的临床意义.方法 随机抽取50例行心脏外科手术患者,入ICU后2h同时测定ScvO2、混合静脉血氧饱和度(S(v)O2)、动脉血乳酸(Lac),并计算氧利用率(O2ER).按ScvO2水平分为A组(ScvO2＜ 0.65,23例)、B组(ScvO2 0.65～0.75,18例)、C组(ScvO2＞ 0.75,9例).分析三组ScvO2与S(v)O2、O2ER的相关性,ScvO2与Lac的相关性以及各组间Lac的差异.比较各组间并发症发生率、机械通气时间和ICU治疗时间.结果 50例患者ScvO2、S(v)O2、O2ER、Lac水平分别为0.656±0.086、0.639±0.081、0.356±0.084、(2.6±1.3) mmol/L.50例患者ScvO2与S(v)O2呈明显正相关(r=0.688,P＜0.01),与O2ER呈明显负相关(r=-0.640,P＜ 0.01).A组Lac与ScvO2呈明显负相关(r=-0.772,P＜0.01),C组Lac与ScvO2呈明显正相关(r=0.717,P＜ 0.05),B组Lac与ScvO2无明显相关性(r=-0.358,P＞0.05).A组及C组Lac水平均明显高于B组[(2.0±0.9)、(4.8±2.1)mmol/L比(1.6±0.5)mmol/L],差异有统计学意义(P＜0.05或＜0.01).A组低氧血症、低心排血量综合征、肾功能损害发生率明显高于B组,C组肝功能损害、肾功能损害发生率也明显高于B组(P＜0.05).A组和C组的机械通气时间和ICU治疗时间均较B组延长(P＜0.05).结论 ScvO2是衡量心脏术后早期患者组织氧供需平衡和预后的良好指标.ScvO2过高或过低均提示组织缺氧,导致术后并发症增加和治疗时间延长.
目的 探討心髒術後早期鑑測中心靜脈血氧飽和度(ScvO2)的臨床意義.方法 隨機抽取50例行心髒外科手術患者,入ICU後2h同時測定ScvO2、混閤靜脈血氧飽和度(S(v)O2)、動脈血乳痠(Lac),併計算氧利用率(O2ER).按ScvO2水平分為A組(ScvO2＜ 0.65,23例)、B組(ScvO2 0.65～0.75,18例)、C組(ScvO2＞ 0.75,9例).分析三組ScvO2與S(v)O2、O2ER的相關性,ScvO2與Lac的相關性以及各組間Lac的差異.比較各組間併髮癥髮生率、機械通氣時間和ICU治療時間.結果 50例患者ScvO2、S(v)O2、O2ER、Lac水平分彆為0.656±0.086、0.639±0.081、0.356±0.084、(2.6±1.3) mmol/L.50例患者ScvO2與S(v)O2呈明顯正相關(r=0.688,P＜0.01),與O2ER呈明顯負相關(r=-0.640,P＜ 0.01).A組Lac與ScvO2呈明顯負相關(r=-0.772,P＜0.01),C組Lac與ScvO2呈明顯正相關(r=0.717,P＜ 0.05),B組Lac與ScvO2無明顯相關性(r=-0.358,P＞0.05).A組及C組Lac水平均明顯高于B組[(2.0±0.9)、(4.8±2.1)mmol/L比(1.6±0.5)mmol/L],差異有統計學意義(P＜0.05或＜0.01).A組低氧血癥、低心排血量綜閤徵、腎功能損害髮生率明顯高于B組,C組肝功能損害、腎功能損害髮生率也明顯高于B組(P＜0.05).A組和C組的機械通氣時間和ICU治療時間均較B組延長(P＜0.05).結論 ScvO2是衡量心髒術後早期患者組織氧供需平衡和預後的良好指標.ScvO2過高或過低均提示組織缺氧,導緻術後併髮癥增加和治療時間延長.
목적 탐토심장술후조기감측중심정맥혈양포화도(ScvO2)적림상의의.방법 수궤추취50례행심장외과수술환자,입ICU후2h동시측정ScvO2、혼합정맥혈양포화도(S(v)O2)、동맥혈유산(Lac),병계산양이용솔(O2ER).안ScvO2수평분위A조(ScvO2＜ 0.65,23례)、B조(ScvO2 0.65～0.75,18례)、C조(ScvO2＞ 0.75,9례).분석삼조ScvO2여S(v)O2、O2ER적상관성,ScvO2여Lac적상관성이급각조간Lac적차이.비교각조간병발증발생솔、궤계통기시간화ICU치료시간.결과 50례환자ScvO2、S(v)O2、O2ER、Lac수평분별위0.656±0.086、0.639±0.081、0.356±0.084、(2.6±1.3) mmol/L.50례환자ScvO2여S(v)O2정명현정상관(r=0.688,P＜0.01),여O2ER정명현부상관(r=-0.640,P＜ 0.01).A조Lac여ScvO2정명현부상관(r=-0.772,P＜0.01),C조Lac여ScvO2정명현정상관(r=0.717,P＜ 0.05),B조Lac여ScvO2무명현상관성(r=-0.358,P＞0.05).A조급C조Lac수평균명현고우B조[(2.0±0.9)、(4.8±2.1)mmol/L비(1.6±0.5)mmol/L],차이유통계학의의(P＜0.05혹＜0.01).A조저양혈증、저심배혈량종합정、신공능손해발생솔명현고우B조,C조간공능손해、신공능손해발생솔야명현고우B조(P＜0.05).A조화C조적궤계통기시간화ICU치료시간균교B조연장(P＜0.05).결론 ScvO2시형량심장술후조기환자조직양공수평형화예후적량호지표.ScvO2과고혹과저균제시조직결양,도치술후병발증증가화치료시간연장.
Objective To investigate the clinical significance of central venous oxygen saturation (ScvO2) monitoring in the patients after cardiac operation.Methods Fifty patients after cardiac operation were randomly selected into this study.After the patients entered ICU 2 h,ScvO2,mixed venous oxygen saturation (S(v)vO2),lactate (Lac) were detected at the same time and oxygen extraction rate (O2ER) was calculated.Fifty patients were divided into three groups according to the level of ScvO2,group A (ScvO2 ＜0.65,23 patients),group B (ScvO2 0.65-0.75,18 patients),group C (ScvO2 ＞ 0.75,9 patients).The correlation among ScvO2,S(v)vO2,O2ER were analyzed.The correlation between ScvO2 and Lac in each group were calculated.The level of Lac in three groups were compared.The incidence rate of complications,ventilator time and ICU stay time were compared.Results The level of ScvO2,S（v）O2,O2ER,Lac in 50patients were 0.656 ±0.086,0.639 ±0.081,0.356 ±0.084,(2.6 ± 1.3) mmol/L.The level of ScvO2 had significantly positive correlation with S(v)O2 (r =0.688,P ＜ 0.01),and had significantly negative correlation with O2ER (r =-0.640,P ＜0.01).In group A,the level of Lac had significantly negative correlation with ScvO2 (r =-0.772,P ＜ 0.01).In group C,the level of Lac had significantly positive correlation with ScvO2 (r =0.717,P ＜ 0.05).In group B,the level of Lac had no significant correlation with ScvO2 (r =-0.358,P ＞0.05).The level of Lac in group A and group C was significantly higher than that in group B [(2.0 ± 0.9),(4.8 ±2.1) mmol/L vs.(1.6 ±0.5) mmol/L] (P ＜0.05 or ＜0.01).The incidence rate of hyoxemia,low cardiac output syndrome and renal functional lesion in group A were significantly higher than those in group B (P ＜ 0.05).The incidence rate of liver functional lesion and renal functional lesion in group C were significantly higher than those in group B (P ＜ 0.05).The ventilator time and ICU stay time in group A andgroup C were significantly longer than those in group B (P ＜ 0.05).Conclusions ScvO2 is an ideal index to judge oxygen equilibrium in early period after cardiac operation.The lower and supranormal ScvO2 both suggest tissue hypoxia,resulting in increased postoperative complications and prolonged treatment.
