摘要
目的 探讨急性放血等容性血液稀释对组织供氧和摄氧的影响。方法 心脏直视手术肝素化前直接从右心房内放血 ,同时经颈内静脉输入等量代血浆 ,以维持有效循环血容量。放血前、后及体外循环期间监测动脉血和混合静脉血气分析 ,根据结果判断放血后及体外循环中机体组织氧供需是否平衡。结果 本组放血量为2 0 0～ 80 0ml ,平均为 5 2 8± 15 2ml;输入代血浆量 4 0 0～ 80 0ml,平均 6 0 6± 182ml。放血前 :混合静脉血氧饱和度(SvO2 )为 0 .74± 0 .0 7,混合静脉血氧分压 (PvO2 )为 4 1.2 0± 4 .2 1mmHg ,动静脉血氧差 (Docta v)为 (2 .77±0 .95 )Vol% ,动脉血氧含量 (Octa)为 (16 .90± 1.6 5 )Vol% ;放血后 :SvO2 为 0 .76± 0 .0 8,PvO2 为 4 2 .4 0± 7.6 0mmHg ,Doc ta v为 (3.90± 0 .4 3)Vol% ,Octa为 (13.70± 1.75 )Vol%。放血后Octa降低 (P≤ 0 .0 1) ,Docta v增大 (P≤ 0 .0 5 ) ,SvO2 和PvO2 无变化 (P >0 .0 5 ) ,体外循环中PvO2 、SvO2 及 pH值均在正常范围内。 结论 肝素化前适量放血急性等容性血液稀释 ,在一定程度上影响组织的氧供给 ,但机体组织摄氧量增加 ,氧供需是平衡的。
Objective To study the effects to the tissue oxygen supply and intake after preoperative acute bloodleting with stable blood volume on 20 adult patients undergoing open heart surgery.Methods Bloodleting was done from right atrium before heparinization,While gelofusine was transfused to keep stable blood volume and hemodynemics.The arterial and mixture venous blood gas were mornitored prior and posterior to heparinizing and during cardiopulmonary bypass.Results The bloodleting volume is 200～800ml(mean:528±152ml),the volume of gelafusione used was 400～800ml(mean:606±182ml).Before bloodleting,oxygen saturation of misture venous blood(SvO 2):0.73±0.07,Oxygen pressure of venous blood(PvO 2):41.20±4.21mmHg,Difference of arterial venous blood oxygen volume(Docta v) was ( 2.77 ±0.95)Vol%,Content of arterial blood oxygen(Octa) was (16.90±1.65)Vol%;after bloodleting,SvO 2 was 0.76±0.08,PvO 2 was 42.40±7.60mmHg,Docta v was (3.90±0.43)Vol%,Octa was (13.70±1.75)Vol%.After bloodleting,Octa were decreased ( P <0.01),Docta v was increased ( P <0.05),SvO 2 and PvO 2 were kept constant ( P > 0.05 ).PvO 2,SvO 2 and pH value were in normal range during CPB.Conclusions Appropriate bloodleting before heparinizing decreases tissue oxygen supply in a certain degree.But tissue oxygen supply and demand were balanced.
出处
《北京医学》
CAS
北大核心
2003年第1期45-47,共3页
Beijing Medical Journal
关键词
常温心脏手术
急性等容性血液稀释
组织供氧
组织摄氧
Acute bloodleting with stable blood volume Tissue oxygen supply Tissue oxygen intake Normothermic cardiopulmonary bypass Open heart surgery
