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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 :2 0例心脏瓣膜置换术病人随机分为两组。观察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 (S VO2 )及动脉血乳酸 (ABL)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 (P <0 0 1) ;降温开始及复温后观察组 VO2 、ERO2 显著低于对照组 (P<0 0 5 )。 (2 )组内S VO2 复温后下降 ,ABL增加 ,与最低温时比较差异非常显著 (P <0 0 1) ;观察组S VO2 在降温开始及复温后显著高于对照组 (P <0 0 5 ) ,ABL复温后显著低于对照组 (P <0 0 5 )。结论 :CPB期间低流量灌注和血液稀释 ,DO2 相对不足的状态下 ,异丙酚减少组织 VO2 、ERO2 ,对改善CPB期间氧供需平衡障碍有明显作用
Objective: To observe the effects of propofol on oxygen supply (DO2), oxygen consumption (VO2), oxygen uptake rate (ERO2) and oxygenation status during heart valve replacement. Methods: Twenty patients with heart valve replacement were randomly divided into two groups. Observation group anesthesia induced and maintained with propofol, the control group with midazolam. The changes of DO2, VO2, ERO2, mixed venous oxygen saturation (S VO2) and arterial blood lactate (ABL) during cardiopulmonary bypass (CPB) were observed. Results: (1) There was no obvious change of DO2 at each time point in the observation group, and the increase of ERO2 in the observation group after rewarming was very significant (P <0.01). The VO2 and ERO2 in the observation group after the start of cooling and after rewarming were significantly lower than those in the control group <0 0 5). (2) S VO2 decreased after rewarming and increased ABL in the group (P <0.01); S VO2 in the observation group was significantly higher than that in the control group at the beginning of rewarming and after rewarming (P < 0 0 5), ABL after rewarming was significantly lower than the control group (P <0 05). CONCLUSIONS: Propofol reduces the tissue VO2 and ERO2 during hypobaric perfusion and hemodilution during CPB, and when DO2 is relatively insufficient, it plays a significant role in improving the balance of oxygen supply and demand during CPB