KẾT QUẢ BƯỚC ĐẦU ÁP DỤNG KỸ THUẬT ĐO BÃO HÒA OXY MÁU TĨNH MẠCH TRỘN ĐỂ THEO DÕI HUYẾT ĐỘNG BỆNH NHÂN PHẪU THUẬT TIM CÓ NGUY CƠ CAO

Abstract

With more and more hospitals establishing and/or expanding their open-heart surgery programs, it is important for clinicians to have a clear understanding of the methods used for patient monitoring. One of the most versatile and probably most misunderstood, is mixed venous oxygen saturation (S O2) and how it relates to cardiac function, oxygen delivery (DO2) and oxygen consumption (VO2).
We randomized 60 patients undergoing elective cardiac surgery to a protocol involving the administration of intravenous fluid and inotropic therapy to attain a target S O2 of at least 70% in first 8h after surgery. Dobutamine was administered in dose of up to 15μg/kg/min where the target S O2 was not achieved with intravenous fluid alone.
Control group patients were administered intravenous fluid and dobutamine to meet goals for pulmonary artery occlusion pressure, cardiac index, arterial pressure, and hematocrit. S O2 was similar in two groups at baseline (67±6%), but there were greater improvements in S O2 in the S O2 group(control group 69±5% vs. S O2 group 71±4%; p<0,001). S O2 guided therapy was associated with a reduction in both ICU stay (29,23±7,82 vs. 40,27 ± 9,04 hours; p<0,001) and the number of patients developing complications
Hemodynamic therapy to attain a target value for S O2 is more appropriate in this context as confounding causes of decreased venous saturation are minimized. This treatment is possible after cardiac surgery where postoperative intensive care admission is a standard of care