心脏体外循环手术后早期检测中心静脉血氧饱和度的临床价值
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摘要
目的探讨心脏体外循环手术后早期检测中心静脉血氧饱和度(ScvO_2)的临床价值。方法选取60例2015年1月至2017年12月在我院行体外循环心外科手术治疗的患者为研究对象,根据ScvO_2水平将其分为A组(ScvO_2≤65%,25例)与B组(ScvO_2>65%,35例)。观察患者术后不同时间段ScvO_2及SaO_2水平,比较两组患者ICU治疗时间、呼吸机使用时间及术后并发症发生情况。结果相较于术后2 h,患者术后6 h的ScvO_2水平逐渐下降,术后12 h时逐渐回升,差异均有统计学意义(P<0.05);术后2、6、12 h,患者的SaO2水平无显著差异(P>0.05)。B组的ICU治疗时间及呼吸机使用时间均显著短于A组,差异具有统计学意义(P<0.05)。B组低心排血量综合征、低氧血症、心律失常及肝肾功能损害发生率均显著低于A组,差异具有统计学意义(P<0.05)。结论 ScvO_2是衡量心脏体外循环手术后早期患者组织氧供需平衡较为敏感的指标,ScvO_2过低则并发症发生率增高,预后较差,因而ScvO_2可作为预测并发症和预后的指标,值得在临床上推广。
Objective To explore the clinical value of early detection of central venous blood oxygen saturation(ScvO_2)after cardiopulmonary bypass. Methods Sixty patients who underwent cardiac surgery under cardiopulmonary bypass from January 2015 to December 2017 were selected as the study objects. According to the level of ScvO_2, patients were divided into group A(ScvO_2≤65%, 25 cases) and group B(ScvO_2>65%, 35 cases). The levels of ScvO_2 and SaO2 at different time points after operation of patients were observed. The treatment time of ICU, the use time of ventilator and the occurrence of complications were compared between the two groups. Results Compared with 2 h after operation, the level of SCvO2 decreased gradually at 6 h after operation, and increased gradually at 12 h after operation, the differences were statistically significant(P<0.05); there were no significant differences in the levels of SaO2 at 2, 6 and 12 h after operation(P>0.05).The ICU treatment time and ventilator use time in the group B were significantly shorter than those in the group A, and the differences were statistically significant(P<0.05). The incidences of low cardiac output syndrome, hypoxemia, arrhythmia and liver and kidney function damage in the group B were significantly lower than those in the group A, and the differences were statistically significant(P<0.05). Conclusion ScvO_2 is a sensitive index to measure the balance of tissue oxygen supply and demand in early patients after cardiopulmonary bypass. If ScvO_2 is too low, the incidence of complications will increase and the prognosis will be poor. Therefore, ScvO_2 can be used as a predictor of complications and prognosis, and it is worth popularizing in clinic.
Objective To explore the clinical value of early detection of central venous blood oxygen saturation(ScvO_2)after cardiopulmonary bypass. Methods Sixty patients who underwent cardiac surgery under cardiopulmonary bypass from January 2015 to December 2017 were selected as the study objects. According to the level of ScvO_2, patients were divided into group A(ScvO_2≤65%, 25 cases) and group B(ScvO_2>65%, 35 cases). The levels of ScvO_2 and SaO2 at different time points after operation of patients were observed. The treatment time of ICU, the use time of ventilator and the occurrence of complications were compared between the two groups. Results Compared with 2 h after operation, the level of SCvO2 decreased gradually at 6 h after operation, and increased gradually at 12 h after operation, the differences were statistically significant(P<0.05); there were no significant differences in the levels of SaO2 at 2, 6 and 12 h after operation(P>0.05).The ICU treatment time and ventilator use time in the group B were significantly shorter than those in the group A, and the differences were statistically significant(P<0.05). The incidences of low cardiac output syndrome, hypoxemia, arrhythmia and liver and kidney function damage in the group B were significantly lower than those in the group A, and the differences were statistically significant(P<0.05). Conclusion ScvO_2 is a sensitive index to measure the balance of tissue oxygen supply and demand in early patients after cardiopulmonary bypass. If ScvO_2 is too low, the incidence of complications will increase and the prognosis will be poor. Therefore, ScvO_2 can be used as a predictor of complications and prognosis, and it is worth popularizing in clinic.
引文
[1]HSIN HT,CHEN LY,LIN PC,et al.Central venous oxygen saturation(ScVO2)facilitates the weaning of intra-aortic balloon pump in acute heart failure related to acute myocardial infarction[J].Int J Cardiol,2013,168(4):4568-4570.
[2]李颖,许卫江,胡述立,等.心脏术后监测中心静脉血氧饱和度的临床意义[J].中国医师进修杂志,2013,36(8):22-24.
[3]姜伟.血氧饱和度与心律失常的变化趋势研究:附500例病例分析[J].中国危重病急救医学,2013,25(2):112-114.
[4]刘辉,刘剑萍,张海英,等.SvO2、P(v-a)CO2、LAC与APACHEⅡ评分、SOFA评分及病情的相关性研究[J].重庆医学,2017,46(10):1326-1329.
[5]张海瑛,潘传亮,刘剑萍,等.混合静脉血氧饱和度联合混合静脉-动脉二氧化碳分压差在评估心肺转流心脏术后患者预后中的价值[J].临床麻醉学杂志,2015,31(7):678-681.
[6]杨房,翟波.ScvO2/乳酸比值结合SOFA评分对先天性心脏病纠治手术预后状况的预测价值[J].重庆医学,2016,45(8):1101-1103.
[7]王红雷,董平栓,尚喜艳,等.急诊经皮冠状动脉介入术中脉搏血氧饱和度监测的临床意义[J].武警医学,2016,27(1):29-31,35.
[8]张骏,吴建义,王黎鹏,等.中心静脉血氧饱和度对心脏术后休克患者容量复苏液体反应性的预测[J].中国心血管病研究,2013,11(10):767-770.
[9]于斌,田慧艳,胡振杰,等.乳酸清除率和中心静脉血氧饱和度指导严重感染患者液体复苏效果的比较[J].中华危重病急救医学,2013,25(10):578-583.
[10]陈玉红,赵钗,赵倩,等.中心静脉血氧饱和度联合静动脉二氧化碳分压差指导脓毒症患者容量管理[J].中国全科医学,2016,19(11):1276-1281.
[11]方卫刚.中心静脉血氧饱和度变化率预测机械通气患者拔管成功率的相关性研究[J].中国急救医学,2016,36(5):448-450.
[12]罗大林.中心静脉血氧饱和度和静动脉二氧化碳差值在感染性休克治疗中的应用价值探讨[J].中国急救医学,2016,36(z1):140-141.
[2]李颖,许卫江,胡述立,等.心脏术后监测中心静脉血氧饱和度的临床意义[J].中国医师进修杂志,2013,36(8):22-24.
[3]姜伟.血氧饱和度与心律失常的变化趋势研究:附500例病例分析[J].中国危重病急救医学,2013,25(2):112-114.
[4]刘辉,刘剑萍,张海英,等.SvO2、P(v-a)CO2、LAC与APACHEⅡ评分、SOFA评分及病情的相关性研究[J].重庆医学,2017,46(10):1326-1329.
[5]张海瑛,潘传亮,刘剑萍,等.混合静脉血氧饱和度联合混合静脉-动脉二氧化碳分压差在评估心肺转流心脏术后患者预后中的价值[J].临床麻醉学杂志,2015,31(7):678-681.
[6]杨房,翟波.ScvO2/乳酸比值结合SOFA评分对先天性心脏病纠治手术预后状况的预测价值[J].重庆医学,2016,45(8):1101-1103.
[7]王红雷,董平栓,尚喜艳,等.急诊经皮冠状动脉介入术中脉搏血氧饱和度监测的临床意义[J].武警医学,2016,27(1):29-31,35.
[8]张骏,吴建义,王黎鹏,等.中心静脉血氧饱和度对心脏术后休克患者容量复苏液体反应性的预测[J].中国心血管病研究,2013,11(10):767-770.
[9]于斌,田慧艳,胡振杰,等.乳酸清除率和中心静脉血氧饱和度指导严重感染患者液体复苏效果的比较[J].中华危重病急救医学,2013,25(10):578-583.
[10]陈玉红,赵钗,赵倩,等.中心静脉血氧饱和度联合静动脉二氧化碳分压差指导脓毒症患者容量管理[J].中国全科医学,2016,19(11):1276-1281.
[11]方卫刚.中心静脉血氧饱和度变化率预测机械通气患者拔管成功率的相关性研究[J].中国急救医学,2016,36(5):448-450.
[12]罗大林.中心静脉血氧饱和度和静动脉二氧化碳差值在感染性休克治疗中的应用价值探讨[J].中国急救医学,2016,36(z1):140-141.