允许性高碳酸血症对非体外循环冠状动脉移植患者血流动力学的影响

摘要

Objective To observe the effect of permissive hypercapnia on hemodynamics in patients undergoing off-pump coronary artery bypass grafting.Methods Sixty ASA physical Ⅱ or Ⅲ patients,aged 48-76,undergoing off-pump coronary artery bypass grafting surgery under general anesthesia,were randomized in two groups:the control group(C group,n=30)and the permissive hypercapnia group(P group,n=30). The patients in C group with tidal volume 10ml/kg,artery PaCO235-45,PH between 7.35-7.45 and the patients in P group with tidal volume 6ml/kg,artery PaCO250-60,PH between 7.3-7.35.Observed and recorded the hemodynamic variables at:the start of surgery(T0),1 hour after the operation start(T1),3 hour after the start of surgery(T2)and at the end of surgery(T3).Results Compared with group C,heart rate,blood pressure and cardiac output in the P group were significantly higher at each time point(P<0.05),the PAP and the PAWP were no significant difference (P>0.05).Conclusions Patients with permissive hypercapnia due to the effective implementation of lung protective ventilation and do cause obvious changes of hemodynamics,making it safely applicable for OPCABG patients.%目的 观察在非体外循环冠状动脉移植(OPCABG)患者术中实施允许性高碳酸血症对血流动力学的影响.方法 选择接受全身麻醉下OPCABG患者60例,年龄48~76岁,ASA分级Ⅱ~Ⅲ级,随机分为对照组(C组,n=30)和允许性高碳酸血症组(P组,n=30).C组术中潮气量10ml/kg,维持动脉PaCO2在35~45mmHg,PH在7.35~7.45之间;P组潮气量6ml/kg,维持动脉PaCO2在50~60mmHg,PH在7.3~7.35之间.观察并记录不同时间点:手术开始(T0),手术开始后1h(T1)、手术开始后3h(T2)和手术结束时(T3)的血流动力学指标.结果 与C组比较,P组患者各时间点心率、血压和心输出量增加(P<0.05),肺动脉压和肺动脉楔压的改变无明显差异(P>0.05).结论 患者术中允许性高碳酸血症由于有效的实施了肺保护性通气且不会使血流动力学发生明显改变,能安全应用于OPCABG患者.