文章摘要
心肺转流下冠状动脉搭桥术呼气末二氧化碳分压与心输出量变化的相关性
Correlation between changes of end tidal carbon dioxide partial pressure and cardiac output during coronary artery bypass grafting under cardiopulmonary bypass
  
DOI：10.12089/jca.2021.03.012
中文关键词: 呼气末二氧化碳分压  心输出量  相关性分析  心肺转流  冠状动脉搭桥术
英文关键词: End-tidal carbon dioxide partial pressure  Cardiac output  Correlation analysis  Cardiopulmonary bypass  Coronary artery bypass grafting
基金项目:河南省医学科技攻关计划项目（201602167）；河南省科技计划项目（172102310686）
作者单位E-mail
陈小莉 471003,洛阳市,河南科技大学第一附属医院麻醉科 cxl353@sina.com 
魏利娟 471003,洛阳市,河南科技大学第一附属医院麻醉科  
耿素娟 郑州市第七人民医院麻醉科  
马亚飞 471003,洛阳市,河南科技大学第一附属医院麻醉科  
郭仲辉 471003,洛阳市,河南科技大学第一附属医院麻醉科  
韩艳艳 471003,洛阳市,河南科技大学第一附属医院麻醉科  
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中文摘要:
      
目的 探讨心肺转流（CPB）下行冠脉搭桥术PETCO2与心输出量（CO）变化的相关性。
方法 选择择期CPB下行冠状动脉搭桥术的患者50例，男32例，女18例，年龄49～73岁，BMI 19～25 kg/m2，ASA Ⅱ—Ⅳ级，采用静-吸复合全身麻醉，丙泊酚、舒芬太尼、顺式阿曲库铵及七氟醚等常规剂量维持麻醉。麻醉后放置Swan-Ganz漂浮导管监测血流动力学参数：CVP、肺动脉压力（PAP）、肺毛细血管楔压（PCWP）、混合静脉血氧饱和度（SO2ETCO2，采用热稀释法测定CO。记录麻醉稳定后5 min（T0）、CPB开始（T1）、CPB灌注流量降至50%（T2）、CPB灌注流量降至25%（T3）、停CPB后10 min（T4）、术毕（T5）的PETCO2、CO。记录T1—T5时 PETCO2、CO分别与T0时 PETCO2、CO的差值（记为ΔPETCO2、ΔCO），进行线性相关与回归分析。
结果 与T0时比较，T1、T2时PETCO2、CO明显降低，T4、T5时CO明显升高（P<0.05）。T1—T5时ΔPETCO2与ΔCO之间存在良好的正相关性（r1=0.744，r2=0.815，r3=0.818，r4=0.810，r5=0.696， P<0.001），其中T2—T4时ΔPETCO2与ΔCO之间的相关性更好。
结论 CPB下冠状动脉搭桥术PETCO2与CO的变化呈现出较好的正相关性。
英文摘要:
      
Objective To investigate the correlation between changes of PETCO2 and cardiac output (CO) during coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB).
Methods Fifty patients, 32 males and 18 females, aged 49-73 years, BMI 19-25 kg/m2, ASA physical status Ⅱ-Ⅳ scheduled for CABG assisted by CPB were selected. The anesthesia was maintained by intravenous inhalation combined with propofol, sufentanil, cisatracurium and sevoflurane. After anesthesia, Swan-Ganz catheter was placed to monitor CVP, PAP, PCWP and SO2ETCO2 was monitored by bypass method and CO was determined by thermal dilution method. PETCO2 and CO were recorded 5 minutes after the maintenance of anesthesia (T0), at the beginning of CPB (T1), CPB perfusion flow decreasing to 50% (T2), CPB perfusion flow decreasing to 25% (T3), 10 minutes after stopping CPB (T4), and at the end of operation (T5). The differences between PETCO2, CO at T1-T5 and PETCO2, CO at T0 (denoted as ΔPETCO2, ΔCO) were recorded and linear correlation and regression analysis were performed.
Results Compared with T0, PETCO2 and CO decreased significantly at T1 and T2, and CO increased significantly at T4 and T5(P < 0.05). There was a good positive correlation between ΔPETCO2 and ΔCO at T1-T5 (r1= 0.744, r2= 0.815, r3= 0.818, r4= 0.810, r5= 0.696, P < 0.001), and the correlation between ΔPETCO2 and ΔCO was better at T2-T4.
Conclusion There was a positive correlation between the changes of PETCO2 and CO during CABG under CPB.
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