腹腔镜手术期间二氧化碳气腹对脑氧供的影响

目的：观察腹腔镜手术期间病人脑氧饱和度（ｒＳＯ２）、脉搏血氧饱和度（ＳｐＯ２）及动脉血二氧化碳分压（ＰａＣＯ２）、ｐＨ值和ＨＣＯ－３浓度等指标的变化，以了解二氧化碳气腹对病人脑氧供的影响。方法：选择行腹腔镜胆囊切除术病人１５例，于气腹前、气腹后２０分钟及术毕３０分钟检测ｒＳＯ２、ＳｐＯ２、ＰａＣＯ２、ｐＨ值和ＨＣＯ－３。结果：气腹后２０分钟ｒＳＯ２和ＰａＣＯ２增高（Ｐ＜０．０１或Ｐ＜０．０５），ｐＨ值降低（Ｐ＜０．０１），ＨＣＯ－３变化不明显。术毕３０分钟ｒＳＯ２、ＰａＣＯ２和ｐＨ值恢复至术前水平，ＳｐＯ２变化无临床意义。ＰａＣＯ２与ｒＳＯ２在气腹期间呈显著正相关（ｒ＝０．７８，Ｐ＜０．０１）。结论：在腹腔镜手术期间，二氧化碳气腹不会对脑氧供产生不良影响。     

心脏瓣膜置换术患者围术期组织氧合变化

目的：观察心脏手术病人围术期组织氧合的变化。方法：选择心脏瓣膜置换术３０例，观察其围术期动脉血氧分压（ＰａＯ２）、动脉血氧饱和度（ＳａＯ２）、混合静脉血分压（ＰｖＯ２）、混合静脉血氧饱和度（ＳｖＯ２）、氧供（ＤＯ２）、氧耗（ＶＯ２）、氧摄取率（ＥＲＯ２）、动脉血乳酸（ＡＢＬ）等指标变化情况。结果：３０例心脏瓣膜置换术患者在围术期常规监测指标ＳａＯ２无显著变化，但ＳｖＯ２、ＤＯ２及ＶＯ２显著下降，ＥＲＯ２及ＡＢＬ明显上升。结论：心脏手术患者在围术期存在一定程度的组织氧合障碍，对其进行组织氧合指标的监测对于指导治疗很有必要。     

重症瓣膜置换术患者围术期氧供,氧耗,氧摄取率和氧合状态的变化

目的：观察重症瓣膜置换术患者围术期氧供需平衡和氧合状态的变化。方法：监测２６例重症瓣膜置换术患者围术期氧供（ＤＯ２）、氧耗（ＶＯ２、氧摄取率（ＥＲＯ２）、混合静脉血氧饱和度（ＳｖＯ２）和动脉血乳酸含量（ＡＢＬ）的动态变化。结果：麻醉诱导后至ＣＰＢ前（ＤＯ２）、ＶＯ２、ＥＲＯ２均下降，ＳｖＯ２升高，与麻醉前比较差异显著或非常显著（Ｐ＜０．０５，Ｐ＜０．０１）。停ＣＰＢ后２０小时内ＤＯ２、ＶＯ２、ＥＲＯ２持续升高，停ＣＰＢ８小时内ＳｖＯ２持续下降，ＡＢＬ持续升高，与ＣＰＢ前时值差异显著或非常显著（Ｐ＜０．０５，Ｐ＜０．０１）。结论：停ＣＰＢ后氧供需平衡障碍、组织缺氧明显存在，且有在一定时间内加重的趋势。     

异丙酚在心脏瓣膜置换术中对氧供、氧耗、氧摄取率及氧合状态的影响

目的：观察异丙酚在心脏瓣膜置换术中对氧供（ＤＯ２）,氧耗（ＶＯ２）,氧摄取率（ＥＲＯ２）及氧合状态的影响。方法：２０例心脏瓣膜置换术病人随机分为两组。组麻醉诱导与维持用异丙酚,对照组用咪唑安定。观察体外循环（ＣＰＢ）期间ＤＯ２,ＶＯ２,ＥＲＯ２,混合静脉血氧饱和度（ＳＶＯ２）及动脉血乳酸（ＡＢＬ０的变化。结果：（１）组内各时点ＤＯ２无明显变化,复温后观察组ＥＲＯ２增加非常显著;降温开始及复温后观察     

门静脉高压患者TIPSS手术前后的氧动力学监测

目的 观察门静脉高压症患者行ＴＩＰＳＳ手术后氧供、氧耗的变化,探讨ＴＩＰＳＳ对机体氧动力学的影响。方法 １４例门脉高压患者ＴＩＰＳＳ治疗,分别手术前、术后３０分钟和术后２周经右颈内静脉置入Ｓｗａｎ－Ｇａｎｚ导管监测血流动力学和氧供、氧耗、氧摄取率。结果 ＴＩＰＳＳ术后患者心脏指数明显增加,氧供明显增加,但氧耗无显著变化。结论 ＴＩＰＳＳ手术加重心脏负担,增加氧供,但机体通过代偿机制能够维持正常氧耗     

低温体外循环心内直视手术麻醉期间脑氧供需平衡状况

心内直视手术３０例，通过监测脑氧饱和度、颈内静脉球部血氧饱和度以及动脉－颈内静脉血乳酸差值，综合分析心内直视手术期间脑氧供需平衡。结果：（１）在体外循环复温过程中，ｒＳＯ２及ＳｊＯ２均明显下降；（２）体外循环开始后，动脉血乳酸和颈内静脉血乳酸进行性增加，但在整个手术麻醉过程中ＡＶＤＬ均未见明显增加，提示：在低温体外循环手术麻醉过程中，复温期间有脑氧供需失衡的趋势，应加强监测，术中若维持ＰａＣＯ２４     

常温不停跳心内直视手术冠脉血心肌酶、SOD、GHS及LPO的变化

目的 观察常温沁脏不停跳心内直视手术与冷停跳手术患者冠脉血心肌酶、超氧化物歧化酶（ＳＯＤ）、谷胱甘肽（ＧＳＨ）、脂质过氧化物（ＬＰＯ）的变化，明确不停跳手术对心肌保护作用。方法 ３６例心内直视手术患者随机分成不停跳与冷停跳组，每组１８例。不停跳组分别于体外循环前、体外循环１５分钟、体外循环停止时、机停后３０、６０分钟采血。冷停跳组分别于体外循环前、主动脉阻断时、主动脉开放时、开放后３０、６０分钟采     

腹部手术全身麻醉期间机体氧耗的临床研究

目的：无创 监测腹部手术麻醉期间病人机体氧耗的变化，并探讨其临床意义。方法：择期腹部手术病人４０例，常规快速诱导插管，行机械呼吸。术中吸入笑气／氧气（５０：５０）混合气体和１．５％左右安氟醚维持麻醉。记录手术开始前５ｍｉｎ和手术开始后３０、６０、９０、１２０、１５０、１８０、２１０、２４０ｍｉｎ时ＦＩＯ２、ＦＥＴＯ２、ＰＥＴＣＯ２、ＭＶ等参数。结果：随着手术时间的延长，ＶＯ２逐渐升高，术毕时的ＶＯ     

吸入不同浓度氧全麻下肺叶手术时氧自由基及肺超微结构的变化

目的：观察吸入不同浓度氧肺叶手术时早期氧自由基和肺超微结构的变化。方法：３１例择期肺叶手术患者，随机分为两组Ｏ组（ＦｉＯ２＝１，ｎ＝１６），Ｎ组（吸入Ｏ２∶Ｎ２Ｏ＝１∶１，ｎ＝１５）。两组麻醉方法基本相同，观察ＳＯＤ和ＭＤＡ在麻醉前、麻醉后２小时、手术结束时和术后２４小时的变化，观察肺切片组织在光镜和电镜下肺超微结构的变化。结果：两组用氧时间ＳＯＤ和ＭＤＡ组间对比，以及ＭＤＡ两组组内对比均无统计学差异（Ｐ＞０．０５）；术后２４小时ＳＯＤ和ＭＤＡ均恢复术前水平。Ｏ组ＳＯＤ麻醉后２小时和手术结束时与术前比较明显下降（Ｐ＜０．０１和Ｐ＜０．０５），Ｎ组ＳＯＤ仅麻醉后２小时下降（Ｐ＜０．０５）。经半定量统计，电镜和光镜肺超微结构病理改变明显，各项指标Ｏ组均较Ｎ组显著。结论：①ＦｉＯ２≥０．５麻醉时，高氧肺损伤早期的生化改变可能主要是Ｏ－２产生增多，ＳＯＤ下降；②ＦｉＯ２≥０．５在５小时内是安全的；③本研究进一步证明全麻时吸入Ｎ２Ｏ－Ｏ２优于纯氧吸入。     

急性等容血液稀释对心脏手术病人血液动力学,氧供,氧耗和脑 …

目的：了解急性等容血液稀释对心脏直视手术病人可能产生的影响，以指导其在体外循环中的应用。方法：观察１６例ＡＳＡⅡ－Ⅲ级择期心脏直视手术病人，接受体外循环前实施２急性等容血稀释，监测病人血液动力学、氧供、氧耗、乳酸浓度等及颈内静脑海氧饱和度等指标的变化。结果：血液稀释后病人的心指数增加了１５．５％，氧供和氧耗无显著变化，氧摄取经无显著变化。颈内静脉血氧饱和度，动脉血乳酸浓度及颈内静脉血乳酸浓度无明显     

肺动脉漂浮导管在冠状动脉旁路术中的应用

目的　评价肺动脉漂浮导管连续监测心排血量 (CO)、混合静脉血氧饱和度 (S VO2 )在冠状动脉旁路移植术 (CABG)中的应用。方法　CABG术者 32例 ,年龄 (6 1 31± 6 92 )岁 ,平均搭桥(3 19± 1 12 )支。麻醉诱导用芬太尼 2 0～ 30 μg/kg、维库溴铵 0 3mg/kg、咪唑安定 (3 5 8± 2 0 0 )mg ;术中以芬太尼、异氟醚维持。经右颈内静脉置CCO S VO2 肺动脉漂浮导管 ,连续监测CO、S VO2 、平均动脉压 (MAP)、肺动脉压 (PAP)、肺毛细血管楔压 (PCWP)和中心静脉压 (CVP)等 ,记录诱导前、插管后、心肺转流 (CPB)前、停CPB及关胸时的数据。结果　心排指数 (CI)、MAP和S VO2 在插管后各时段较诱导前明显下降 (P <0 0 5 ) ,CVP、PCWP及PAP停CPB后较插管后升高 (P <0 0 5 )。HR在插管后下降 (P <0 0 5 ) ,停CPB后升高 (P <0 0 5 )。结论　在CABG术中 ,利用肺动脉漂浮导管连续监测CO、S VO2 及各项相关指标 ,及时了解心脏功能、全身及心肌的氧供需平衡状况 ,并调整用药 ,以利于围手术期意外的处理 ,防止心肌缺血的发生     

Effects of mild hypothermic cardiopulmonary bypass on blood viscoelasticity in coronary artery bypass grafting patients

The purpose of this study was to determine the changes in blood viscoelasticity during and after coronary artery bypass grafting (CABG) and to identify correlations between blood viscoelasticity and patients' age, duration of cardiopulmonary bypass (CPB), and cross-clamp time. After Institutional Review Board approvals, patients (n = 10) who were subjected to mild hypothermic CPB were included in this study. Viscosity and elasticity were measured at strains of 0.2, 1, and 5 using a Vilastic-3 Viscoelasticity Analyzer. Arterial blood samples were collected pre-CPB, on normothermic CPB, hypothermic CPB, after rewarming, and after CPB. Viscosity and elasticity at strains of 0.2 and 1 were altered significantly during and after CPB compared to the pre-CPB (p < 0.01). In particular, elasticity of blood was diminished during normothermic bypass and could not be recovered after CPB (p < 0.01). Although there were strong correlations between blood viscoelasticity, duration of CPB, and cross-clamp time on normothermic CPB, only the patients' age showed a positive correlation between viscosity (r = 0.61, p = 0.05), and elasticity (r = 0.89, p < 0.001) after CPB. These results suggest that mild hypothermic CPB alters the blood viscoelasticity during and after CABG.     

1,6-二磷酸果糖对心肺转流期间氧代谢的影响

目的研究1,6-二磷酸果糖(FDP)对心肺转流(CPB)手术期间氧代谢的影响。方法随机将24例CPB手术病人均分成研究组(A组)和对照组(B组)。A组于转机前静滴FDP200mg/kg,B组于转机前滴入等量生理盐水,观察麻醉后(T1)、CPB前(T2)、升主动脉开放后10min(T3)、停CPB后10min(T4)、停CPB后60min(T5)的氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)及动脉血乳酸(ABL)的变化。结果两组T3时DO2明显降低(P<0.05),T3时A组ERO2和B组VO2、ERO2及两组T4、T5时VO2、ERO2明显增加(P<0.05或P<0.01),T3、T4和T5时ABL明显增加(P<0.01);B组T3、T4和T5时VO2、ERO2、ABL明显高于A组(P<0.05)。结论FDP对改善CPB手术期间氧供需平衡障碍有明显作用。     

Effects of dopamine on oxygen consumption and gastric mucosal blood flow during cardiopulmonary bypass in humans

We investigated the effects of flow rate and dopamine on systemic oxygen delivery (DO2) oxygen consumption (VO2) and gastric mucosal microcirculatory blood flow (gMCF), measured by laser Doppler flowmetry in 12 patients undergoing mild hypothermic (34 degrees C) cardiopulmonary bypass (CPB). The first intervention comprised increasing CPB flow rates from 2.4 to 3.0 litre min-1 m-2, and the second intervention administering dopamine 6 micrograms kg-1 min-1. Measurements were made before and 10 min after the start of one of the two interventions. The heart remained in cardioplegic arrest throughout the study. There were no significant differences in variables between the two baseline measurements preceding the interventions. The increase in CPB flow rate increased DO2 and gMCF without affecting VO2. At constant flow rate, dopamine also increased gMCF with no change in VO2, DO2 or mean arterial pressure. Our data suggested that dopamine had no flow-independent effect on VO2 and that it increased gMCF during constant flow hypothermic CPB.      

Comparison of parameters for detection of splanchnic hypoxia in children undergoing cardiopulmonary bypass with pulsatile versus nonpulsatile normothermia or hypothermia during congenital heart surgeries

The aim of this study is to evaluate gastric mucosal oxygenation together with whole-body oxygen changes in infants undergoing congenital heart surgery with cardiopulmonary bypass (CPB) procedure and the use of either pulsatile or nonpulsatile mode of perfusion with normothermia and pulsatile or nonpulsatile moderate hypothermia. Sixty infants undergoing congenital cardiac surgery were randomized into four groups as: nonpulsatile normothermia CPB (NNCPB, n = 15), pulsatile normothermia CPB (PNCPB, n = 15), nonpulsatile moderate hypothermia CPB (NHCPB, n = 15), and pulsatile moderate hypothermia CPB (PHCPB, n = 15) groups. In NNCPB and PNCPB groups, mild hypothermia was used (35°C), whereas in NHCPB and PHCPB groups, moderate hypothermia (28°C) was used. Gastric intramucosal pH (pHi), whole-body oxygen delivery (DO(2)) and consumption (VO(2)), and whole-body oxygen extraction fraction were measured at sequential time points intraoperatively and up to 2 h postoperatively. The measurement of continuous tonometry data was collected at desired intervals. The values of DO(2), VO(2), and whole-body oxygen extraction fraction were not different between groups before CPB and during CPB, whereas the PNCPB group showed higher values of DO(2), VO(2), and whole-body oxygen extraction fraction compared to the other groups at the measurement levels of 20 and 60 min after aortic cross clamp, end of CPB, and 2 h after CPB (P < 0.0001). Between groups, no difference was observed for pHi, lactate, and cardiac index values (P > 0.05). This study shows that the use of normothermic pulsatile perfusion (35°C) provides better gastric mucosal oxygenation as compared to other perfusion strategies in neonates and infants undergoing congenital heart surgery with CPB procedures.     

Whole body oxygen consumption after hypothermic cardiopulmonary bypass

Whole body oxygen consumption and the substrate for energy production during the post-bypass period have not been clarified. We hypothesized that the substrate composition for energy production during post-bypass period might be different from that during pre-bypass period because of surgical diabetic state induced by hypothermic cardiopulmonary bypass (CPB). We measured whole body oxygen consumption, carbon dioxide production and respiratory quotient by the gas exchange method using the Datex Deltatrac before and after hypothermic cardiopulmonary bypass. We also measured oxygen consumption by Ficks principle. Whole body oxygen consumption (P 0.001) and carbon dioxide production (P 0.05) increased significantly above pre-CPB values after the termination of CPB. Respiratory quotient (P 0.01) decreased significantly below pre-CPB values after the termination of CPB. We conclude that oxygen consumption increased significantly above pre-bypass values after the termination of hypothermic cardiopulmonary bypass at least under the fentanyl, diazepam, chlorpromazine anesthesia with continuous infusion of nitroglycerin and nicardipine. The changes in respiratory quotient suggest a relatively higher ratio of lipid metabolism for energy production during post-bypass period.(Maruyama K, Hashimoto H, Nakamura K, et al.: Whole body oxygen consumption after hypothermic cardiopulmonary bypass. J Anesth 7: 1–7, 1993)     

常温不停跳冠状动脉搭桥术对机体氧供需的影响

目的：研究常温心脏不停跳冠状动脉搭桥术对机体氧供需平衡的影响。方法：16例冠心病患者，在咪唑安定，芬太尼，丙泊酸，维库溴铵及异氟醚静吸复合麻醉下，心脏不停跳行冠状动脉搭桥手术，术中监测ECG，SpO2及血液动力学指标。于冠脉血管吻合前后，分别取挠动脉及肺动脉血，测定血红蛋白（Hb)和动脉血氧饱和度（SaO2)，并计算全身氧供需平衡，结果：冠状动脉搭桥前后CaO,CvO2,DO2,VO2,O2ER,A-aDO2等均无明显变化（P＞0．05），CO搭桥后比搭桥前增加，但无显著性差异，结论：常温心脏不停跳冠状动脉搭桥手术对全身氧供需平衡没有明显影响。     

Oxygen metabolism during and after cardiac surgery: role of CPB

BACKGROUND: Cardiopulmonary bypass (CPB) has been reported to increase oxygen metabolism and to influence the relation between oxygen consumption (VO(2)) and delivery (DO(2)) in the early hours after cardiac surgery. To investigate the role of CPB, we studied oxygen metabolism in coronary artery bypass procedures performed on-pump (CABG) and off-pump (OPCAB). METHODS: Twenty-five patients were randomized to undergo CABG (n = 14) or OPCAB (n = 11). All patients received the same anesthetic management. Oxygen metabolism variables were assessed before induction of anesthesia and up to 18-hours after surgery. RESULTS: At baseline, before induction of anesthesia, there were no differences between CABG and OPCAB in oxygen consumption (VO(2)), delivery (DO(2)), or extraction (ExO(2)). After surgery VO(2) and ExO(2) increased in both groups, while DO(2) decreased. No significant differences between CABG and OPCAB were detected in postoperative VO(2), DO(2), and ExO(2) levels. The relation between VO(2) and DO(2) was very similar in CABG and OPCAB patients throughout the study, and no significant differences were detected in slopes and intercepts of the regression lines between CABG and OPCAB at all time points. There was, however, a significant effect of time on the relation between VO(2) and DO(2): this relation was stronger in the postoperative period, and the slope of this relation increased over time as well. CONCLUSIONS: A hypermetabolic state and progressive and significant increases in the strength of the relationship between VO(2) and DO(2) and in the slope of this relationship occur after both CABG and OPCAB. Cardiopulmonary bypass is not responsible for these changes in oxygen metabolism.