摘要
目的 :探讨异丙酚对体外循环 (CPB)各阶段脑氧及乳酸代谢的影响。方法 :选择心内直视手术病人 31例 ,随机分为异丙酚组 (A组 ) 16例 ,对照组 (B组 ) 15例。分别于CPB前、降温至 33℃和 30℃、低温期、复温至 30℃和33℃以及CPB后 15分钟七个时点测定动脉、颈内静脉血气及乳酸值 (LA) ,并计算脑摄氧率 (O2 Ext)及动脉 颈内静脉乳酸差值 (AVDL)。结果 :两组颈内静脉氧饱和度 (SjO2 )于低温期均明显升高 ,复温时降低 ,SjO2 <6 0 %者占 2 3% (A组 4/16 ,B组 3/15 ) ,两组间无差异 (P >0 0 5 )。B组复温期O2 Ext较低温期增加 (P <0 0 5 )。CPB开始后两组LA均升高并持续至CPB结束。两组AVDL始终接近零 ,LA无差异 (P >0 0 5 )。CPB结束后LA与CPB时间在B组呈正相关 (R =0 744 3,P <0 0 0 1) ;A组二者无相关性 (R =0 0 30 3,P >0 5 )。结论 :CPB复温期间有发生脑氧供需失衡趋势。异丙酚可降低O2 Ext。
Objective: To evaluate the effects of propofol on cerebral oxygen and lactate metabolism in various stages of cardiopulmonary bypass(CPB).Methods:Thirty one patients under CPB were devided randomly to propofol group (group A, n= 16) and control group (group B, n= 15).The changes of arterial and jugular venous hemogolbin saturation (SjO 2),oxygen content,lactate value were observed before CPB, during cooling stage, stable hypothermia,rewarming stages and after CPB.Cerebral oxygen extraction(O 2Ext) and lactate differences between arterial and jugular bulb blood(AVDL) were calculated.Results:SjO 2 in both groups increased significantly during cooling stages,decreased during rewarming stages. During rewarming stage,O 2Ext increased in group A and didnot change in group B.Lactate in two groups increased dramatically after onset of CPB and maintained high after CPB,but AVDL didnot change at all times.There appeared to be a significant correlation between the duration of CPB and lactate after CPB(r=07334,P<0001)in group B,but no correlation in group A(r=00303,P>0).Conclusion:Propofol can decrease O 2Ext of rewarming phase during CPB and prevent lactate elevating by prolonged CPB.
出处
《临床麻醉学杂志》
CAS
CSCD
2000年第2期70-73,共4页
Journal of Clinical Anesthesiology
关键词
异丙酚
体外循环
乳酸
脑氧代谢
Propofol Cardiopulmonary bypass Jugular venous hemoglobin saturation Cerebral oxygen extraction Lactate
