發(fā)布時(shí)間：2018-06-25 03:03

  本文選題：動(dòng)靜脈二氧化碳分壓差 + 胸腔鏡�。� 參考：《濟(jì)寧醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:探討動(dòng)靜脈二氧化碳分壓差(Pcv-aCO2)在完全胸腔鏡體外循環(huán)下心臟手術(shù)中的應(yīng)用價(jià)值。方法:隨機(jī)選取2013年1月到2014年10月濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院心臟外科連續(xù)收治擬體外循環(huán)下行心臟手術(shù)的患者共100例,其中男性62例,女性48例,年齡21-63歲,平均年齡36歲,平均體重51kg。房間隔缺損(ASD)39例;室間隔缺損(VSD)34例;風(fēng)濕性二尖瓣狹窄10例,二尖瓣關(guān)閉不全12例,狹窄伴關(guān)閉不全5例。所有患者均經(jīng)心電圖、胸部X線片和超聲心動(dòng)圖檢查確診。50例在全麻低溫體外循環(huán)完全胸腔鏡下行手術(shù)治療的先天性心臟病或風(fēng)濕性心臟病患者為研究組,同期相似病種常規(guī)開胸手術(shù)患者50例為對(duì)照組。所有患者均采用氣管插管全身麻醉,在低溫、體外循環(huán)下施行手術(shù)。研究組采用胸腔鏡手術(shù),右腋中線3切口心臟停跳下完成手術(shù),對(duì)照組,胸骨正中切口,心臟停跳后直視下完成心臟手術(shù),常規(guī)關(guān)胸。研究組經(jīng)股動(dòng)脈插供血,經(jīng)股靜脈或者上腔靜脈插管建立體外循環(huán),而對(duì)照組采取經(jīng)典胸部正中切口,常規(guī)插管建立體外循環(huán),采用主動(dòng)脈根部冷血停搏液心肌保護(hù)。術(shù)中經(jīng)頸內(nèi)靜脈或鎖骨下靜脈留置中心靜脈導(dǎo)管,通過(guò)血?dú)夥治鲇?jì)算出Pcv-aCO2,同時(shí)記錄監(jiān)測(cè)中心靜脈血氧飽和度(ScvO2)。術(shù)后返回ICU均給予呼吸機(jī)輔助呼吸,呼吸機(jī)模式和參數(shù)設(shè)置要求相同。術(shù)后經(jīng)橈動(dòng)脈采動(dòng)脈血,經(jīng)中心靜脈置管采中心靜脈血,分別監(jiān)測(cè)患者術(shù)后0h、6h、12h、18h四個(gè)時(shí)間點(diǎn)的Pcv-aCO2和ScvO2變化,心臟彩超評(píng)估術(shù)后0h、6h、12h、18h的心臟功能(左室射血分?jǐn)?shù)EF值)。術(shù)后0h、6h、12h、18h四個(gè)不同時(shí)間點(diǎn)指標(biāo)的比較,應(yīng)用重復(fù)測(cè)量資料的方差分析;應(yīng)用spearman分析各指標(biāo)的相關(guān)性,P0.05認(rèn)定為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:在進(jìn)行胸腔鏡心臟手術(shù)后0h、6h、12h、18h的Pcv-aCO2逐漸降低,ScvO2及EF逐漸增加,各時(shí)間點(diǎn)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);Pcv-aCO2、ScvO2、EF三個(gè)指標(biāo)兩組之間比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);三個(gè)指標(biāo)處理與時(shí)間交互作用比較差異也均有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后Pcv-aCO2與Scv O2呈負(fù)相關(guān)(r=-0.602;P=0.006),Pcv-aCO2與EF呈負(fù)相關(guān)(r=-0.502;P=0.032)。結(jié)論:Pcv-aCO2的檢測(cè)較動(dòng)脈血?dú)夥治龈芸陀^反映患者體內(nèi)氧供需平衡情況,根據(jù)Pcv-aCO2監(jiān)測(cè)結(jié)果并結(jié)合ScvO2以及其他臨床數(shù)據(jù),能夠及時(shí)有效地進(jìn)行臨床處理措施指導(dǎo),盡早預(yù)測(cè)和評(píng)估術(shù)后并發(fā)癥,從而在臨床上能盡早預(yù)防和及時(shí)有效處理并發(fā)癥。Pcv-aCO2和ScvO2之間具有相關(guān)性,可用于手術(shù)前中后期的血?dú)庵笜?biāo)監(jiān)控和心臟功能的評(píng)估和預(yù)后的判讀。
[Abstract]:Objective: to investigate the value of arteriovenous carbon dioxide partial pressure difference (Pcv-aCO2) in cardiac surgery under complete thoracoscopic cardiopulmonary bypass (CPB). Methods: a total of 100 patients, 62 males and 48 females, aged 21-63 years, with an average age of 36 years, were selected randomly from January 2013 to October 2014 in the Cardiac surgery Department of the affiliated Hospital of Jining Medical College. The average weight was 51 kg. There were 39 cases of atrial septal defect (ASD), 34 cases of ventricular septal defect (VSD), 10 cases of rheumatic mitral stenosis, 12 cases of mitral insufficiency and 5 cases of stenosis with insufficiency. All the patients were diagnosed by electrocardiogram, chest X-ray and echocardiography. The study group consisted of 50 patients with congenital heart disease or rheumatic heart disease who were operated under general anesthesia cardiopulmonary bypass (CPB). At the same time, 50 patients with similar diseases were treated as control group. All patients were anesthetized by endotracheal intubation and operated under hypothermia and cardiopulmonary bypass. The patients in the study group underwent thoracoscopic surgery, right axillary midline 3 incision cardiac arrest, control group, median sternum incision, cardiac surgery under direct vision after cardiac arrest, and conventional closure of chest. In the study group, cardiopulmonary bypass (CPB) was established through femoral artery catheterization, femoral vein or superior vena cava catheterization, while in the control group, cardiopulmonary bypass was established by classical chest median incision and conventional catheterization. Cardiopulmonary bypass was protected by cold blood cardioplegic solution from aortic root. The central venous catheter was inserted through the internal jugular vein or subclavian vein during the operation. Pcv-aCO2 was calculated by blood gas analysis, and the central venous oxygen saturation (scvO2) was recorded. All the patients returned to ICU after operation were given ventilator assisted breathing, and the requirements of ventilator mode and parameter setting were the same. Arterial blood was collected through radial artery and central vein was inserted into central vein to collect central venous blood. The changes of Pcv-aCO2 and scvO2 were monitored at 0 h, 6 h, 12 h and 18 h, respectively. Cardiac function (EF value of left ventricular ejection fraction) was evaluated by echocardiography at 0 h, 6 h, 12 h and 18 h, respectively. The analysis of variance of repeated measurement data was used to compare the four different time points of 0 h ~ 6 h ~ 12 h ~ (18 h) after operation, and the correlation of each index was analyzed by spearman (P0.05). Results: Pcv-aCO2 decreased gradually after thoracoscopic cardiac surgery at 0 h, 6 h and 12 h and 18 h after thoracoscopic cardiac surgery, and the levels of scvO2 and EF increased gradually. There were significant differences in the three indexes of Pcv-aCO2O2EF between the two groups (P0.05), and there were also significant differences between the three indexes of processing and time interaction (P0.05). There was a negative correlation between Pcv-aCO2 and scvO2 (rcv-0.602P0. 006) Pcv-aCO2 and EF (rcv-0.502a CO _ 2 was 0.032). Conclusion compared with arterial blood gas analysis, the detection of Pcv-aCO2 can objectively reflect the balance of oxygen supply and demand in patients. According to the monitoring results of Pcv-aCO2 and SCVO _ 2 and other clinical data, the clinical management can be guided in time and effectively. To predict and evaluate the postoperative complications as early as possible, so as to prevent and deal with the complications. Pcv-aCO2 and ScvO2 in clinical as early as possible. It can be used to monitor the blood gas index before and after operation, to evaluate the cardiac function and to interpret the prognosis.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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相關(guān)期刊論文 前2條

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本文編號(hào)：2064249