网络首发:2012-11-20,
纸质出版:2012
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混合静脉血氧饱和度评估心脏外科围术期的风险[J]. 中山大学学报(医学科学版), 2012,33(6).
Effect of Mixed Venous Oxygen Saturation in Evaluation of Perioperative RiskinCardiac Surgery[J]. Journal of Sun Yat-sen University (Medical Sciences), 2012, 33(6).
【目的】 分析混合静脉血氧饱和度(SvO2)对心脏外科围术期风险评估的价值及其预警值。【方法】 170例心脏手术后病人到达ICU时通过经胸壁肺动脉导管采取标本测量SvO2。分析SvO2与围术期危险因素以及预后的关系,运用统计学计算SvO2对术后并发症的预警值,并将预警值作为分组界值将病人分组进行比较,验证SvO2与心脏外科围术期并发症及预后的关系。【结果】 SvO2的预警值为53.5%。A组(SvO2 ≤ 53.5%)22例; B组(SvO2 > 53.5%)148例。 A组EuroSCORE (The European System for Cardiac Operative Risk Evaluation)评分(4.6 ± 3.4)明显高于B组(2.8 ± 2.3; P = 0.015)。A组与B组相比,术后由于心包填塞或出血剖胸探查率18.18 % vs 2.03 % (P = 0.006),术后脑梗死率13.6 % vs 1.5 % (P = 0.016),术后第1天胶体液用量(1 587 ± 732)mL vs (1 091 ± 785)mL (P = 0.002),住院死亡率18.18 % vs 1.35% (P = 0.003)等显著高于B组。4例(2.4%)发生频发室性早搏,拔除经胸壁肺动脉导管后心律失常消失。拔除经胸壁肺动脉导管后无一例发生导管相关出血。【结论】 经胸壁肺动脉导管取血测量SvO2安全经济。SvO2对心脏外科围术期风险可做出可靠的评估。
【Objective】 Mixed venous oxygen saturation (SvO2) is often used in cardiac surgeryto evaluate perioperative oxygen supply-and-demand balance and hemodynamic performance. The aim of the presentstudy was to define a cutoff point of SvO2 to evaluate perioperative risks in cardiacsurgery. 【Method】 One hundred and seventy patients underwent different cardiac surgeryincluding AVR, MVR, CABG, double valve procedure, combined procedures, aortic surgerywith circulation arrest,and acute CABG/valvular surgery. An epidural catheter wasput intra-operatively through the chest wall and the anteriorwall of the right ventricle into pulmonary artery as a trans-thoracicpulmonary artery catheter (TPAC) in all patients. SvO2 from TPAC on admission toICU were analyzed in relation to NYHA classification, EuroSCORE, aortic clampingtime, drain amount, colloid demand, postoperative stroke, length of ICU stay, andhospital mortality. A cutoff point of SvO2 was defined with ROC analysis. 【Result】Lower SvO2 associated with higher mortality. The best cutoff point was 53.5%. Thepatients were divided into two groups according to the cutoff point: 22 patientswith SvO2≤53.5% in group A and 148 patients with SvO2 >53.5% in group B. EuroSCOREin group A (4.6 ± 3.4) was significantly higher than group B (2.8 ± 2.3; P = 0.015),as was hospital mortality 18.18 % vs 1.35 % (P = 0.003), reoperation for bleeding/tamponade18.18 % vs 2.03% (P = 0.006), postoperative stroke 13.6% vs 1.5% (P = 0.016), andcolloid demand in the first postoperative day (1587 ± 732)mL vs (1091 ± 785)mL (P= 0.002). Four patients (2.4%) had in the first hours in ICU premature ventricularcontraction which disappeared soon after TPAC was removed. No TPAC related bleedingwas found after removal of the catheter. 【Conclusion】 SvO2 can be used quantitativelyto evaluate perioperative risks in a mixed cardiac surgery population and showedgood correspondence with EuroSCORE. TPAC is a safe and inexpensive method for samplingof SvO2.
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