双瓣膜置换患者围术期心排血量与呼出气二氧化碳的关系

目的 探讨双瓣膜置换术患者围术期心排血量监测，提高手术安全性和预测患者预后，及时调整治疗方案。方法 根据Ｆｉｃｋ原理将呼出气二氧化碳（ＥＴＣＯ２）监测用于估计患者围术期心排血量（ＣＯ），并与有创性温度稀释法进行比较。将１９９１年１０月以来随机选择２０例双瓣膜置换患者分为两组，对照组：使用常规心肌保护液；用药组：常规心肌保护液中加入山莨菪碱，３０ｍｇ／Ｌ。常规体外循环，冠状窦逆行灌液，分别于麻醉前、

Relationship Between Cardiac Output and End-tidal Carbon Dioxide Tension in Patients During and after Mitral and Aortic Double Valve Replacement

Objective In order to improve quality of perioperative care and to predict the outcome for patients undergoing mitral and aortic double valve replacement(DVR), we tried to utilize end tidal carbon dioxide (ETCO 2), according to Fick's principle to estimate cardiac output(CO) with comparsion by conventional invasive thermodilution method. Methods Since Oct. 1991, 20 patients with DVR were selected randomly.Control group( n=10) conventional cardioplegia and medicative group( n=10) with anisodamine 30mg/L in cardioplegic solution. Cardiopulmonary bypass(CPB) was carried out routinely. Swan Ganz catheter was inserted into pulmonary artery and retrograde coronary sinus perfusion was used in all patients. Cardiac index(CI),left ventricular stroke work index (LVSWI),right ventricular stroke work index(RVSWI),systemic vascular resistance (SVR),pulmonary vascular resistance(PVR), ETCO 2, arterial partial pressure of arterial carbon dioxide (PaCO 2) were measured at preanaesthetic, prebypass, end of bypass, end of operation, postoperative 2 hours, 4 hours, 8 hours, 12 hours and 24 hours. Results Using anisodamine in cardioplegic solution, correlation between ETCO 2 and CO was found consistent and positive, while in the control group intrapulmonary shunt might play an important role in interferring this correlationship. Conclusion Anisodamine can improve the pulmonary circulation, reduce intrapulmonary blood shunt and render ETCO 2 to reflect CO change more correctly.