摘要
【目的】观察盐酸戊乙奎醚（PHC）对体外循环瓣膜置换术患者脑氧合和血乳酸的影响。【方法】成人择期行体外循环二尖瓣瓣置换术（MVR—CPB）患者59例，随机分为两组：盐酸戊乙奎醚组（PHC组，n=31）和对照组（C组，n=28）。麻醉诱导前10min分别静注PHC0．02mg／kg和等体积生理盐水。于麻醉诱导后10min（Tc）、降温稳定后10min（T1）、停机循环稳定后10min（T2）采集桡动脉和颈内静脉球部血行血气分析，a稳态处理血气。记录动脉氧分压（PaO2）、静脉氧分压（PivO2）、动脉氧饱和度（SaO2）、静脉氧饱和度（sjvO2）、动脉乳酸（AL）和静脉乳酸（VL）；计算动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2）、动脉-颈内静脉血氧含量差（CajvO2）、脑氧摄取率（ERO2）及脑乳酸净产量（ADVL）；记录患者苏醒时间（PD）、ICU生命支持时间（SD）和住院时间（HD）。【结果】两组PaO2、CaO2、Ca—jvO2、ERO2、PjvO2、SjvO2以及AL、VL和ADVI。在T1～T2时刻与T0比较均有差异（P〈0．05）；与C组比较，PHC组T1、T2时刻Pa02高、而Ca—jvO2和ERO2低（P〈0．05）。两组各时点AL—VL和ADVL比较无差异（P〉0．05）；PD、SD和HD组间比较无差异（P〉0．05），但PHC组均短于C组。【结论】盐酸戊乙奎醚可降低MVR—CPB患者脑氧耗，维持CPB中氧供需平衡，减轻体外循环导致的脑损伤；缩短患者苏醒时间，减少ICU生命支持时间和住院时间。
[Objective] To observe the effect of penehyclidine hydrochloride（PHC） on cerebral oxygenation and blood lactic acid in patients undergoing mitral valve replacement surgery with cardiopulmonary bypass （MVR CPB）. [Methods] Totally 59 patients undergoing MVR-CPB were randomly divided into PHC group （ n =31） and control group（C group, n =28）. PHC 0.02mg/kg and isovolumic normal saline were intravenously injected 10min before anesthesia induction, respectively. Blood samples of radial artery and internal glo mus jugulare 10min after induction（T0 ）, 10rain after stable hyperthermia（T1 ） and 10min after the end of CPB （T2） were obtained for blood gas analysis. Arterial oxygen pressure（PaO2 ）, venous oxygen pressure（PjvO2 ）, arterial oxygen saturation（SaO2 ）, venous oxygen saturation（SjvO2 ）, arterial lactic acid（AL） and venous lactic acid（VL） were recorded. Oxygen content（CaO2, CjvO2 ） and arterial-venous oxygen content difference（CajvO2）, oxygen uptake rate（ERO2 ） and plasma lactic acid of cerebrum（AVDL） were calculated. The duration of palinesthesia （PD）, life supporting time in ICU（SD） and length of stay（HD） were recorded. [Results]In both groups, PaO2 , CaO2 , Ca-jvO2 , ERO2 , PjvO2 , SjvO2 , AL, VL and ADVL at T1 and T2 were different from at To （ P 〈0.05）. Compared with group C, PaO2 at T1 and T2 were higher, and Ca jvOz and ERO2 were lower in group PHC （ P 〈0.05）. There were no differences in AL, VL and ADVL at each time point between groups（ P〉0. 05）. There were no differences in PD, SD and HD between groups（ P 〉0. 05）, but those in group PHC were shorter than those in group C. [Conclusion]PHC can decrease cerebral oxygen consumption in MVR-CPB patients, maintain cerebral oxygen balance during CPB, alleviate brain injury caused by CPB, shorten the duration of palinesthesia and reduce the life supporting time in the ICU and length of stay.
出处
《医学临床研究》
CAS
2010年第12期2270-2273,共4页
Journal of Clinical Research
关键词
体外循环
心脏瓣膜假体植入
氧/代谢
乳酸/A液
extracorporeal circulation
heartr valve prosthesis implantation
oxygen/MT
lactic acid/BL
