摘要
目的观察瓣膜置换手术患者体外循环(cardiopulmonary bypass,CPB)前后P_(ET)CO_2和PaCO_2关系的变化,以明确体外循环后监测P_(ET)CO_2能否反映PaCO_2的变化。方法择期行体外循环瓣膜置换手术患者30例,ASA分级Ⅱ~Ⅲ级。分别于切皮前、关胸前、缝皮时抽取动脉血行血气分析,记录同时点P_(ET)CO_2。计算动脉-潮气末二氧化碳分压差[D(a-ET)CO_2],肺泡-动脉氧分压差[D(A-a)O_2],氧合指数(OI)。结果与切皮前比较,PaO_2,OI在CPB后降低,D(A-a)O_2升高(P<0.05)。PaCO_2、P_(ET)CO_2、D(a-ET)CO_2各时点比较无差别(P>0.05)。结论心脏瓣膜置换手术CPB后,D(A-a)O_2升高,PaO_2、OI降低,发生肺氧弥散功能下降,但不影响P_(ET)CO_2和PaCO_2的相关性。
Objective To determine whether PETCO2 can reflect the changes of PaCO2 after cardiopulmonary bypass （CPB） by investigating the correlation of PETCO2 and PaCO2 before and after CPB in patients undergoing cardiac valve replacement surgery. Methods Thirty patients undergoing cardiac valvular replace surgery, ASA Ⅱ-Ⅲ level, were enrolled. Arterial blood gas analysis was performed immediately before surgical incision and sternal closure as well as after surgical suture. The values of arterial-end-tidal carbon dioxide pressure difference [D（a- ET）CO2], alveolar-arterial oxygen pressure difference [D（A-a）O2] and oxygenation index （OI, PaO2/FiO2） were calculated respectively. Results Compared with those before surgical incision, PaO2 and OI were significantly decreased and D（A-a）O2 was increased before sternal closure and after surgical suture, respectively （P〈0.05）. While there were no significant differences in PaCO2, PETCO2, D（a-ET）CO2 at each time point, respectively （P〉0.05）. Conclusion In patients undergoing cardiac valve replacement surgery, pulmonary gas exchange worsens after CPB, but the correlation of PETCO2 and PaCO2 does not change.
出处
《创伤与急诊电子杂志》
2017年第2期65-67,共3页
Journal of Trauma and Emergency(Electronic Version)
