低温体外循环心脏瓣膜置换手术胃粘膜pH, 胃粘膜PCO2 与变化.docVIP

低温体外循环心脏瓣膜置换手术胃粘膜pH、胃粘膜PCO2的变化 邵兵 刘琴湘 郭训 刘玉妍 广东省清远市人民医院 暨南大学医学院第五附属医院麻醉科（广东 清远511500） 【】PiCO2）的变化。方法 17例心脏瓣膜置换术病人，分别于CPB转机前(T1)、转机30min(T2)、循环恢复后15min(T3)、停机前（T4）、停机60min(T5)、术后6h(T6)测定PaCO2和PiCO2 ，计算pHi。结果 与T1比较，T3、T4、T5时间点PiCO2明显增高，pHi明显降低（p0.01或p0.05）；结论。低温体外循环期间存在胃粘膜低灌流和酸中毒，胃粘膜产生CO2增加。胃粘膜pH（pHi ）和 PiCO2能反映CPB期间存在胃粘膜低灌流和酸中毒。 【】Changes of gastric intramucosal PCO2 and gastric intramucosal pH during hypothermic cardiopulmonary bypass of cardiac valve replacement SHAO Bing, LIU Qinxiang, GUO Xun , et al.. Department of Anesthesiology,The People,s Hospital of Qingyuan City,The Fifth Affiliated of Medical College of Jinan University ，Qingyuan 511500 ，China 【】To investigate the changes of gastric intramucosal PCO2（PiCO2） and gastric intramucosal pH(pHi) during hypothermic cardiopulmonary bypass（CPB） of cardiac valve replacement. Methods 17 patients undergoing cardiac valve replacement under CPB were selected. PaCO2 and PiCO2 were measured and pHi were calculated before CPB(T1), at 30 min after intermission of CPB (T2) , 15 min after the cirulation recovery , the end of CPB(T4) , 60 min after completion of CPB(T5) and 6h after the surgery(T6) respectively. Results The PiCO2 increased and pHi decreased significantly at T3，T4 and T5 compared with T1（p0.01or p0.05）. Conclusion There were gastric mucosal hypoperfusion and acidosis during hypothermic CPB.The increased PiCO2 was primarily related to an increased production of CO2 in the gastric mucosal.The gastric mucosal hypoperfusion and acidosis during CPB might be measured by pHi and PiCO2. 【】cardiopulmonary bypass；gastric intramucosal pH；gastric intramucosal PCO2；acidosis；cardiac valve replacement ]，可作为组织氧供与氧耗的敏感监测指标[3]。大量实验和临床研究已证明pHi是反映胃肠粘膜缺血缺氧最敏感的指标[4,5]。pHi持续降低的病人死亡率高。因此，监测CPB期间pHi能预测术后并发症的发生。心内直视手术病人在低温心肺转流(CPB)期间及术后均可能发生胃粘膜低灌流和酸中毒，由此导致术后并发症增多[6]。本研究旨在观察心脏瓣膜置换手术病人心肌缺血再灌注后胃粘膜PC02、pHi的变化,评价pHi监测的临床意义。 1 资料与方法 1.1一般资料 择期心脏辨膜置换手术病人17例，其中男6例，女11例，年龄34—55岁，体重47~63kg，心功能II~IV级。疾病种类为风湿性二尖瓣病变13例，二尖瓣及主动脉瓣