医学论文-体外循环中空气法胃粘膜pH值与氧供 氧耗的变化.docVIP

医学论文-体外循环中空气法胃粘膜pH值与氧供 氧耗的变化 ???????????????????? 作者：胡序凯 吴国荣 吴一霄 陈骏萍 【摘要】? 　　目的 观察体外循环(CPB)中空气法胃粘膜pH值与氧供、氧耗的变化了解体外循环期间胃粘膜的血流灌注。 方法 选择择期行体外循环心脏手术30例，麻醉后置入TONO胃管通过空气法胃粘膜张力模块自动持续监测胃粘膜二氧化碳分压(PgCO2)，在监护仪中输入麻醉诱导后30min、体外循环30min、60min、停体外循环后30min和60min时间点的动脉和混合静脉血气分析结果，计算获得各时点的胃粘膜pH值（pHi）、氧供(DO２)和氧耗(VO２)等数据。 结果 PgCO2在CPB期间明显低于术前（P＜0.01），停CPB后恢复到术前水平；pHi的变化体外环循期间显著升高（P＜0.01），停CPB后恢复术前水平；DO２和VO２变化：CPB期间明显低于术前（P＜0.01），停CPB后明显高于CPB期间（P＜0.01），停CPB 60min后明显高于术前（P＜0.01）。结论 本研究中的病例在低温体外循环期间未存在胃肠粘膜血流灌注不足。 【关键词】? 体外循环 空气法胃张力 胃粘膜PgCO2 胃粘膜pH值 氧供 氧耗 　　【Abstract】? Objective? To observe the change of gastric air tonometric pH, oxygen delivery ,oxygen consumption and gastric mucosal perfusion during cardiopulmonary bypass (CPB), during CPB.?? Methods? Thirty elective cardiac surgery patients were observed. Gastric PCO2 was measured from a nasogastric tube by an automated system of air tonometry. Record the arterial and mix venous blood-gas results in after indication 30 min, CPB30 min, CPB 60 min, 30 min and 60 min after the end of CPB. Input these blood-gas results to the monitor calculated the pHi, oxygen delivery and oxygen consumption in these observe points.? Results? PgCO2 during CPB was significantly lowered compared with that of preoperation (P0.01), and returned to preoperation level when after CPB. pHi during CPB was significant up versus preoperation (P0.01), and returned to preoperation level when after end the CPB. DO2 and VO2 in during CPB were significantly lower preoperation (P0.01), those after CPB were significantly higher than those during CPB (P0.01). Conclusion? The patient’s gastric mucosal perfusion is maintained well during hypothermic CPB. 　　【Key words】? Cardiopulmonary bypass? Air Tonometry? Intramucosal PgCO2? Gastromucosal pH? Oxygen delivery? Oxygen consumption 　　体外循环(CPB)中的独特生理状态可能导致的全身炎性反应综合征，血液与CPB管道和氧合器的接触所引起的补体、凝血系统的激活及组织的损伤等可能引起内脏器官缺血，国内采用空气法胃粘膜二氧化碳分压(PgCO2)监测CPB中胃粘膜pH值变化的报道较少。作者自2004年2月至2006年10月观察心脏手术CPB患者空气法胃粘膜pH值（pHi）与氧供（DO2）、氧耗（VO2）的变化，现报道如下。 　　1? 临