发绀患者体外循环中不同氧浓度管理对心肌的影响

目的 观察在发绀患者心内畸形矫治术中使用不同氧浓度管理对心肌的影响.方法 选择2009年1月至2011年9月期间74例发绀型先心病患者随机分为两组：常规组37例,采用氧浓度（FiO2）80%～100%、动脉氧分压（PaO2） 300～380 mm Hg启动体外循环（CPB）;逐级增氧组37例,FiO2 20%、PaO2 80～100 mm Hg启动CPB,在随后10～30 min逐渐增加FiO2 30%～50%,CPB中控制血流复温前PaO2≤130 mm Hg,血流复温后PaO2逐级增加至200～300 mm Hg,保持红细胞压积28%～30%,灌注流量100～180 ml/kg.监测心肌生化变化：气管插管后（T1）、CPB后10 min（T2）、升主动脉开放（CCR）后10 min（T3）、术后6 h（T4）及24 h（T5）抽外周血监测肌酸激酶同工酶（CK-MB）及肌钙蛋白I（cTnI）浓度.结果 CK-MB及cTnI浓度：气管插管后、CPB后10 min两组差异无统计学意义（P＞0.05）;CCR 10 min、术后6 h及24 h逐级增氧组水平显著低于常规组（P＜0.05）.结论 发绀患者CPB中采用逐级增氧管理模式,通过缩小CPB和患者自身的氧分压差,减少自由基等生成,可降低CK-MB及cTnI释放,从而减轻心肌损伤.

Effects of different oxygen concentration on myocardial effects in cyanosis patients during extracorporeal circulation

Objective To observe the effects of different oxygen concentrations using intraoperative of heart malformation correction on myocardial in patients with cyanosis. Methods From 2009 January to 2011 September 74 patients with cyanotic congenital heart disease were randomly divided into two groups, a group of 37 patients for the conventional group, the oxygen concentration （80%-100% FiO2）, arterial partial pressure of oxy- gen （PaO2） 300-380 mm Hg priming of cardiopulmonary bypass （CPB）; another group of 37 patients for sequential aerobic group, FiO2 20%, PaO2 80-100 mm Hg start CPB, in the subsequent 10-30 minutes gradually with the increase of FiO2 30%-50%, in the CPB control blood rewarming before PaO2 130 mm Hg, blood rewarming after PaO2 gradually increased to 200-300 mm Hg, maintain hematocrit of 28%-30%, the perfusion flow rate of 100-180 ml/kg. Peripheral blood CK-MB and cTnI concentration were monitored after tracheal intubation （T1）, CPB 10 min （T2）, open up the （CCR） 10 min （T3）, 6 hours after operation （T4） and 24 hours （T5） pumping separately. Results The concentration of CK-MB and cTnI concentrations after tracheal intubation, CPB 10 min in two groups has no difference（P〉0.05）, but CCR 10 min, after 6 hours,24 hours of graded reoxygenation groups was significantly lower than that of the conventional group （P〈0.05）. Conclusion The patients with CPB with cyanosis graded reoxygenation management mode, through the reduction of CPB and the patient＇s own oxygen difference, reduce free radical generation, can reduce the CK-MB and cTnI release, thereby reducing myocardial injury.