中心静脉与混合静脉血氧饱和度监测术后血容量变？…

目的 比较中心静脉血氧饱和度（ｃｅｎｔｒａｌ ｖｅｎｏｕｓ ｏｘｙｇｅｎ ｓａｔｕｒａｔｉｏｎ，ＳｃｖＯ２，经右心房）与混合静脉血氧饱和度（ｍｉｘｅｄ ｖｅｎｏｕｓ ｓａｔｕｒａｔｉｏｎ，ＳｖＯ２，经肺动脉）在监测心脏术后血容量（ＢＶ）变化时的意义。方法 ２４例心脏手术后患者，分别于术后进入ＩＣＵ处于机械通气及睡眠状态（Ⅰ组）；术后６小时处于机械通气及清醒状态（Ⅱ组）；术后２０小时处于自主呼吸及清     

中心静脉与混合静脉血氧饱和度监测术后血容量变化的比较

目的比较中心静脉血氧饱和度（ｃｅｎｔｒａｌｖｅｎｏｕｓｏｘｙｇｅｎｓａｔｕｒａｔｉｏｎ，ＳｃｖＯ２，经右心房）与混合静脉血氧饱和度（ｍｉｘｅｄｖｅｎｏｕｓｏｘｙｇｅｎｓａｔｕｒａｔｉｏｎ，ＳｖＯ２，经肺动脉）在监测心脏术后血容量（ＢＶ）变化时的意义。方法２４例心脏手术后患者，分别于术后进入ＩＣＵ处于机械通气及睡眠状态（Ⅰ组）；术后６小时处于机械通气及清醒状态（Ⅱ组）；术后２０小时处于自主呼吸及清醒状态（Ⅲ组）；同时测定ＳｃｖＯ２，ＳｖＯ２，ＢＶ和其他血流动力学指标并进行相关分析。结果ＳｃｖＯ２与ＢＶ相关系数（ｒ）分别为Ⅰ组０．５８９１（Ｐ＜０．０１），Ⅱ组０．５５９０（Ｐ＜０．０１），Ⅲ组０．６９６２（Ｐ＜０．０１）；ＳｖＯ２与ＢＶｒ分别为Ⅰ组０．７８５６，Ⅱ组０．７７８１（Ｐ＜０．０１），Ⅲ组０．７２４３（Ｐ＜０．０１）；ＳｃｖＯ２与ＳｖＯ２ｒ分别为Ⅰ组０．８６８９，Ⅱ组０．８９７１，Ⅲ组０．９５１３（Ｐ＜０．０１）。表明ＳｃｖＯ２与ＢＶ，ＳｖＯ２在心脏术后不同状态下具有相关性。结论ＳｃｖＯ２能代替ＳｖＯ２作为反映心脏术后ＢＶ变化的一种监测指标     

混合静脉血氧饱和度与心脏指数关系研究及临床应用

近年来，ＳｖＯ２与ＣＩ关系引起了许多学者 麻醉，危重病人，特别是心脏手术后患者监测中，ＣＩ是观察病情，稀量治疗效果，估计预后的一个重要指标，多数学者认为，ＳｖＯ２与ＣＩ相关甚好，要以通过间断或连续测量ＳｖＯ２来了解ＣＩ情况，从而指导临床治疗。     

冠脉搭桥手术病人的心脏指数和混合静脉血氧饱和度的相关性研究

目的：对８５例接受３￣５根冠脉搭桥手术病人测得的围术期混合静脉血氧饱和度和心脏指数（ＣＩ）等血流动力学指标进行统计学分析，探索其相关性。方法：采用有光纤的５腔肺动脉漂浮导管，分别在六个时相采取血流动力学参数；麻醉前基础值，气管插管后５分钟，锯开胸骨后，体外循环停机后，术后６和２４小时。结果：ＳｖＯ２与ＣＩ在各时相无显著改变或高于术前水平。各时相ＳｖＯ２和ＣＩ与对照值之差间显示较好的相关性。结论：     

混合静脉血氧饱和度与心脏指数关系研究及临床应用

近年来,S(?)O_2与CI关系引起了许多学者重视。在麻醉、危重病人、特别是心脏手术后患者监测中,CI是观察病情、衡量治疗效果、估计预后的一个重要指标。多数学者认为,S(?)O_2与CI相关甚好,可以通过间断或连续测量S(?)O_2来了解CI情况,从而指导临床治疗。本文就近年来各作者有关S(?)O_2与CI关系研究及临床应用的报道作简要综述。     

心脏手术中持续混合静脉血氧饱和度监测的临床意义

在１０例体外循环心脏手术患者中研究了持续监测混合静脉血氧饱和度（ＳｖＯ２）的临床意义及其与心排血量（ＣＯ）的关系。结果表明，ＳｖＯ２与ＣＯ呈显著的正相关（Ｙ＝４６＋２．５×，ｒ＝０．９１，Ｐ＜０．０１）。在麻醉平稳的条件下，ＳｖＯ２降低可反映心功能早期的变化，从而可使患者得到及时的处理。作者认为，在心脏手术患者中持续监测ＳｖＯ２，对指导临床麻醉具有重要的意义。     

心脏术后早期混合静脉血氧饱和度水平的临床研究

目的研究心脏术后早期混合静脉血氧饱和度（SvO2）水平与围术期因素、术后并发症的关系.方法记录95例心脏手术患者术后12 h内的每小时SvO2、心指数（CI）.按SvO2均数分为＜60%（Ⅰ组,n=10）、60%～70%（Ⅱ组,n=45）、＞70%（Ⅲ组,n=40）三组.统计各组患者年龄、术前左室射血分数（LVEF）、体外循环时间、主动脉阻断时间（ACT）、ICU停留时间、术前基础疾病和在院期间并发症发生数.结果各组间年龄、LVEF、基础疾病发生数无显著性差异.Ⅰ组的ACT、体外循环时间、ICU停留时间较Ⅱ、Ⅲ组显著延长,CI降低,循环及呼吸系统并发症发生率升高（P＜0.05）.结论某些围术期因素可降低心脏术后早期SvO2水平.SvO2水平低时增加并发症的发生率,延长ICU停留时间.     

重症心脏瓣膜置换术病人围术期混合静脉血氧饱和度与心输出量 …

混合静脉血氧饱和度 (Ｓ ｖＯ2 )不仅可动态反映组织氧供需平衡、评价药物的疗效 ,早期发现意外事件和判断病人的预后 ,而且Ｓ ｖＯ2 可反映心输出量 (ＣＯ)的变化[1 3 ] 。研究发现 ,多种危重病人Ｓ ｖＯ2 与ＣＯ有良好的相关性[2 ,4 ] 。心脏手术期间 ,尤其是术后早期 ,Ｓ ｖＯ2 与ＣＯ是否存在相关性 ,Ｓ ｖＯ2 能否正确反映ＣＯ的变化 ,目前存在较大的争议[5,6] 。本研究是观察重症心脏瓣膜置换术病人围术期Ｓ ｖＯ2 与ＣＯ的相关性 ,并对其影响因素进行探讨分析。资料与方法一、病例选择　重症风湿性心脏病需行瓣膜置换术病人 32例 ,男…     

心排血量对混合静脉血氧饱和度与中心静脉血氧饱和度相关性的影响

混合静脉血氧饱和度(SO_2)在危重病人的监测中很有价值,但插入肺动脉导管有一定困难和危险.以往研究表明,中心静脉血氧饱和度(ScvO_2)与SO_2有很好的相关性,但心排血量对这种相关性的影响如何尚无报告.为此,作者进行了观察研究.     

急性肾衰竭患者心脏指数与中心静脉压、下腔静脉管径呼吸变异指数关系的相关研究

<正>因各种原因导致的急性肾功能损伤是急诊常见的重症疾病,通常需急诊肾脏替代治疗(continuous rernal replacement therapy,CRRT)治疗。针对患者的高血容量状态一般选用CVVH模式,但如果一味控制液体的摄入,随着CRRT的进行,就很有可能出现低血容量状态,找到一种快速、简捷、有效的评估方法在临床上是非常重要的。本研究回顾性的记录了我院     

混合静脉血氧饱和度的连续监测及其临床意义

新一代光纤导管氧饱和度仪(Oximetrix)能连续监测混合静脉血氧饱和度(SvO_2)。本文报道8例心内直视手术及2例神经外科手术中应用Oximetrix系统连续监测SvO_2的结果,同时抽取肺动脉血作血气分析以便对照,并使用温度稀释法测定CO。结果表明:全麻期间,心内直视手术SvO_2维持在70～80％.神经外科手术维持在80～90％;氧运送(DO_2)和氧消耗(VO_2)减少,以VO。更为明显。Oximetrix系统显示的SvO_2和肺动脉血气分析的SvO_2及用温度稀释法测定的CO间均有显著的相关性,相关系数分别为0.98(P<0.001)和0.68(P<0.01)。作者认为SvO_2下降与以下因素有关:1.供氧减少;2.耗氧增多;3.血流动力学异常。     

心脏手术后中心静脉压测定的临床意义

目的 探讨中心静脉压（ＣＶＰ）在心脏术后的临床意义。方法 随机选择心脏术后患者２４例,均在三种状态下进行对比研究：（１）患者术毕进入ＩＣＵ处于机械通气状态;（２）术后８小时处于机械通气及清醒状态;（３）术后２４小时处于自主呼吸和清醒状态。分别测定ＣＶＰ、血容量（ＢＶ）、心脏指数（ＣＩ）和其它血流动力学指标,对ＣＶＰ与血流动力学指标之间进行相关分析。结果 ＣＶＰ与ＢＶ在术后不同状态下均无相关性,而与     

Continuous Metabolic Monitoring in Infant Cardiac Surgery: Toward an Individualized Cardiopulmonary Bypass Strategy

Cardiopulmonary bypass (CPB) in infants is associated with morbidity due to systemic inflammatory response syndrome (SIRS). Strategies to mitigate SIRS include management of perfusion temperature, hemodilution, circuit miniaturization, and biocompatibility. Traditionally, perfusion parameters have been based on body weight. However, intraoperative monitoring of systemic and cerebral metabolic parameters suggest that often, nominal CPB flows may be overestimated. The aim of the study was to assess the safety and efficacy of continuous metabolic monitoring to manage CPB in infants during open‐heart repair. Between December 2013 and October 2014, 31 consecutive neonates, infants, and young children undergoing surgery using normothermic CPB were enrolled. There were 18 male and 13 female infants, aged 1.4 ± 1.7 years, with a mean body weight of 7.8 ± 3.8 kg and body surface area of 0.39 m². The study was divided into two phases: (i) safety assessment; the first 20 patients were managed according to conventional CPB flows (150 mL/min/kg), except for a 20‐min test during which CPB was adjusted to the minimum flow to maintain MVO₂ >70% and rSO₂ >45% (group A); (ii) efficacy assessment; the following 11 patients were exclusively managed adjusting flows to maintain MVO2 >70% and rSO2 >45% for the entire duration of CPB (group B). Hemodynamic, metabolic, and clinical variables were compared within and between patient groups. Demographic variables were comparable in the two groups. In group A, the 20‐min test allowed reduction of CPB flows greater than 10%, with no impact on pH, blood gas exchange, and lactate. In group B, metabolic monitoring resulted in no significant variation of endpoint parameters, when compared with group A patients (standard CPB), except for a 10% reduction of nominal flows. There was no mortality and no neurologic morbidity in either group. Morbidity was comparable in the two groups, including: inotropic and/or mechanical circulatory support (8 vs. 1, group A vs. B, P = 0.07), reexploration for bleeding (1 vs. none, P = not significant [NS]), renal failure requiring dialysis (none vs. 1, P = NS), prolonged ventilation (9 vs. 4, P = NS), and sepsis (2 vs. 1, P = NS). The present study shows that normothermic CPB in neonates, infants, and young children can be safely managed exclusively by systemic and cerebral metabolic monitoring. This strategy allows reduction of at least 10% of predicted CPB flows under normothermia and may lay the ground for further tailoring of CPB parameters to individual patient needs.     

Analysis of the Factors Related to a Decrease in Jugular Venous Oxygen Saturation in Patients with Diabetes Mellitus During Normothermic Cardiopulmonary Bypass

Purpose We sought to examine what factors, including cerebrovascular carbon dioxide (CO₂) reactivity, are related to a decrease in internal jugular venous oxygen saturation (SjvO₂) during normothermic cardiopulmonary bypass (CPB) in patients with diabetes mellitus.Methods Twenty-three diabetic patients scheduled to undergo elective coronary artery bypass grafting were studied. As a control, 27 age-matched control patients without diabetes mellitus were also examined. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to continuously monitor SjvO₂. Arterial and jugular venous blood gases were measured during CPB. The cerebrovascular CO₂ reactivity was measured after the induction of anesthesia and before the start of surgery using a 2.5-MHz pulsed transcranial Doppler probe.Results The SjvO₂ values in the diabetic group were lower than those in the control group at the initiation of CPB and at 20, 40, and 60 min after the start of CPB. The values for pre- and post-CO₂ reactivity in the control group did not significantly differ (pre-CPB: 4.8% ± 2.3% mmHg⁻¹; post-CPB: 5.9% ± 4.4% mmHg⁻¹). In contrast, the values for CO₂ reactivity were lower post CPB than pre-CPB in the diabetic group (Pre-CPB: 6.3% ± 2.9% mmHg⁻¹; post-CPB: 4.7% ± 2.6% mmHg⁻¹; P < 0.05). In the diabetic group, glycosylated hemoglobin A1c (HbA1c) is considered to be a factor related to a decrease in SjvO₂ during CPB.Conclusions Cerebrovascular CO₂ reactivity in diabetic patients decreased after the cessation of CPB but not in the control patients. In addition, HbA1c is also thought to be a factor related to a decrease in SjvO₂ in diabetic patients.