成人心脏围术期胶体渗透压变化及其临床意义

目的 探讨成人心脏外科手术围术期血浆胶体渗透压(COP)的变化规律。方法 选择21例行成人心脏外科手术的患者,根据手术不同分为体外循环瓣膜置换组(CPB组)、微创不停跳冠脉搭桥组(OP组)。记录麻醉后5min(T0)、体外循环开始后5min/搭桥血管远端时(T1)、体外循环结束后5min/搭桥血管近端时(T2)、手术结束返回ICU(T3)、术后2h(T4)、4h(T5)、8h(T6)、24h(T7)的COP,以及术后3d检验指标的变化、机械通气时间、ICU时间等数据。比较各时间点的数据差异。结果 所有患者术前基本情况相同。2组患者围术期COP均有下降,但组间比较差异无统计学意义(P0.05)。CPB组在术中COP变化值最明显,差异有统计学意义(P0.05)。2组的并发症发生率及术后ICU时间、机械通气时间比较,差异均无统计学意义(P0.05)。结论 心脏体外循环手术可使COP下降,但通过纠正COP均能恢复正常,对临床预后无明显影响。

The tendency of plasma colloid osmotic pressure in perioperative period and its clinical significance in adult patients who undergoing cardiac surgery

Objective To observe the tendency of colloid osmotic pressure (COP) in perioperative period and the influence of COP change on the clinical prognosis .Methods Totally 21 adult patients undergoing cardiac surgery were divided into 2 groups :cardiopulmonary bypass in valve replacement group (CPB ,n=11) ,off‐pump coronary artery bypass grafting group (OP ,n=10) . COP of blood samples in 8 points(5 min after anesthesia (T0) ,5 min after the beginning of cardiopulmonary bypass(CPB)/5 min after suturing the distal of the graft vessel (T1) ,5 min after the ending of CPB/5 min after suturing the proximal of the graft vessel (T2) ,returned to ICU (T3) ,2 h (T4) ,4 h(T5) ,8 h (T6) ,24 h (T7) after operation from patients were tested .We also collected the datas of laboratory tests in 48 h ,mechanical ventilation time ,ICU time .Looking for the tendency of COP changing and effects on clinical prognosis .Results All patients were in the same basic situation .The COP were decreased during the cardiac surgery ,but there was no significant difference between the 2 groups (P>0 .05) .However ,the value of COP changes in the CPB group(△T1) was the most significant (P<0 .05) .There was no difference in the postoperative complications ,ICU time ,and the time of mechani‐cal ventilation between the groups (P>0 .05) .Conclusion Cardiopulmonary bypass surgery can make the colloid osmotic pressure decreasing ,but by correcting ,the CPB can return to normal in the end of surgery .There is no significant impact on clinical progno‐sis .