CAJ | 학술논문

目的：探讨冠状动脉旁路移植术(CABG﹚在体外循环与非体外循环下围术期胃黏膜pH值(PHi﹚、混合静脉血氧饱和度(SvO2﹚、血乳酸(Lac﹚的变化。方法选取我院2013年6月~2014年1月60例多支冠状动脉病变患者。按是否进行体外循环(CPB﹚随机分为OPCAB组和CCABG组,每组30例。观察术前(T1﹚、术中予鱼精蛋白时(T2﹚、术后4 h(T3﹚3个时点PHi、SvO2、Lac变化,并记录两组患者ICU停留时间、气管插管留置时间、呼吸机使用时间、住院时间。结果在T2时,OPCAB组的PHi高于CCABG组,SvO2低于CCABG组,差异有统计学意义(P<0.05﹚。在T3时,OPCAB组的胃黏膜PHi、SvO2高于CCABG组,Lac低于CCABG组,有显著性差异(P<0.05﹚。OPCAB组患者气管导管留置时间、呼吸机使用时间短于CCABG组。结论非体外循环冠状动脉旁路移植术有利于术中胃黏膜和脏器的保护,减少围术期的并发症,减少患者ICU时间、呼吸机使用时间、气管导管留置时间。
목적：탐토관상동맥방로이식술(CABG﹚재체외순배여비체외순배하위술기위점막pH치(PHi﹚、혼합정맥혈양포화도(SvO2﹚、혈유산(Lac﹚적변화。방법선취아원2013년6월~2014년1월60례다지관상동맥병변환자。안시부진행체외순배(CPB﹚수궤분위OPCAB조화CCABG조,매조30례。관찰술전(T1﹚、술중여어정단백시(T2﹚、술후4 h(T3﹚3개시점PHi、SvO2、Lac변화,병기록량조환자ICU정류시간、기관삽관류치시간、호흡궤사용시간、주원시간。결과재T2시,OPCAB조적PHi고우CCABG조,SvO2저우CCABG조,차이유통계학의의(P<0.05﹚。재T3시,OPCAB조적위점막PHi、SvO2고우CCABG조,Lac저우CCABG조,유현저성차이(P<0.05﹚。OPCAB조환자기관도관류치시간、호흡궤사용시간단우CCABG조。결론비체외순배관상동맥방로이식술유리우술중위점막화장기적보호,감소위술기적병발증,감소환자ICU시간、호흡궤사용시간、기관도관류치시간。
Obecjtive To explore the meaning of PHi, SvO2 and Lac change in perioperative period on extracorporeal circulation and non extracorporeal circulation coronary artery bypass grafting. Methods A total of 60 patients who were diagnosed with multivessel coronary artery disease and undergoing elective surgery from June 2013 to January 2014 were randomly assigned into two groups, 30 cases in each group. The density of Phi, SvO2, and Lac change in three time points, preoperation(T1), when used protamine in operation (T2) and 4 hours after operation(T3) were analyzed. ICU detention time, tracheal intubation time, respirator using time and length of hospital stay were recorded as well. Results In T2, comparing with the group of CCABG, the density of PHi in gastric mucosa was higher in the group of OPCAB, the density of SvO2 was lower than CCABG, there were significant differences (P<0.05). In T3, as for the group of OP-CAB, the density of PHi and SvO2 in gastric mucosa was higher than the group of CCABG, and the density of Lac was lower than CCABG, the results were significantly (P<0.05). However, ICU detention time, tracheal intubation time, res-pirator using time were shorter in the group of OPCAB. Conclusion Non extracorporeal circulation coronary artery by-pass grafting is better for protecting gastric mucosa and organs, can reduce the complications in perioperative period, shorten the time of staying in ICU, using tracheal catheter and respirator.