体外循环搏动灌注对脑氧代谢及肾功能的影响

目的评价体外循环(CPB)心脏手术主动脉阻断期间采用搏动灌注对患者脑氧代谢及肾功能的影响。方法选取2009年6月至12月间在CPB下手术治疗的风湿性心脏瓣膜病患者40例,随机分为搏动灌注组(P组)20例和非搏动灌注组(NP组)20例。主动脉阻断期间P组应用人工心肺机自身的滚压泵通过转速改变形成搏动血流进行灌注,NP组采用常规平流灌注。分别于术前及术后24 h抽取静脉血检测血肌酐、尿素氮;诱导后(T1)、主动脉阻断后10 min(T2)、主动脉开放前(T3)、停机后25 min(T4)经桡动脉及颈静脉球部采血行血气分析,测定颈静脉球部氧饱和度(SjvO2)及动脉乳酸。观察手术期间尿量。计算脑动静脉氧含量差(AjvDO2)、氧摄取率(CERO2)。结果 P组与NP组比较显示:主动脉开放前P组SjvO2明显高于NP组(P0.05),而AjvDO2、CERO2水平则明显低于NP组(P0.05),术中乳酸明显较低(P0.05);单位时间尿量明显多于NP组(P0.05)。结论 CPB心脏手术采用搏动灌注的脑氧代谢和肾保护作用优于平流灌注。

Effects of pulsatile perfusion on the cerebral oxygen metabolism and renal function during cardiopulmonary bypass

OBJECTIVE To evaluate the clinical effects of pulsatile perfusion on the cerebral oxygen metabolism and renal function during cardiopulmonary bypass（CPB）.METHODS From June to December 2009,40 patients with rheumatic heart valve diseases undergoing open heart surgery were randomized into pulsatile group（P,n=20） and nonpulsatile group（NP,n=20）.The pulsatile flow was applied during aortic cross-clamping by roller pump head of heart-lung machine in P group.Following parameters were examined： SjvO2,blood lactate,urine volume,blood urea nitrogen,creatinine.Brain consult-arterio-jugular differences of oxygen（AjvDO2） and cerebral metabolic rate of oxygen（CERO2） were calculated.RESULTS The SjvO2 during X-clamping and urine volume during CPB was significant higher in the pulsatile group（P〈0.05）.The AjvDO2 and CERO2 during X-clamping and blood lactate level during CPB were significant lower in the pulsatile group（P〈0.05）.CONCLUSION The pulsatile flow is better than nopulsatile flow in oxygen metabolism of brain and renal protection.