中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
11期
1293-1295
,共3页
压力%体外循环%呼吸功能试验%静态膨肺
壓力%體外循環%呼吸功能試驗%靜態膨肺
압력%체외순배%호흡공능시험%정태팽폐
Pressure%Extracorporeal circulation%Respiratory function tests%Pulmonary static inflation
目的 评价不同压力静态膨肺对体外循环(CPB)心脏瓣膜置换术后肺功能的影响.方法 择期行体外循环心脏瓣膜置换术患者60例,ASA分级Ⅱ或Ⅲ级,体重47 ～ 78 kg,年龄26 ～ 70岁,采用随机数字表法,将其分为2组(n=30).CPB期间机械通气停止后,予持续静态膨胀,呼吸环路压力分别维持于,5 cmH2O(L组)或10 cm H2O(H组).于切皮前,CPB结束后1、3和6h时,抽取动脉血样行血气分析.计算肺泡气-动脉血氧分压差[D(A-a)O2]、呼吸指数(RI)、氧合指数(OI),记录术后留置气管导管时间和ICU停留时间.结果 与L组比较,H组CPB结束后1、3、6h时D(A-a)O2和RI降低,OI升高,OI＜ 300 mm Hg的发生率明显降低(P＜0.05),术后留置气管导管时间和ICU停留时间差异无统计学意义(P＞0.05).结论 心脏瓣膜置换手术CPB期间,静态膨肺采用10 cm H2O压力比5cm H2O压力可以更好地改善术后肺弥散功能.
目的 評價不同壓力靜態膨肺對體外循環(CPB)心髒瓣膜置換術後肺功能的影響.方法 擇期行體外循環心髒瓣膜置換術患者60例,ASA分級Ⅱ或Ⅲ級,體重47 ～ 78 kg,年齡26 ～ 70歲,採用隨機數字錶法,將其分為2組(n=30).CPB期間機械通氣停止後,予持續靜態膨脹,呼吸環路壓力分彆維持于,5 cmH2O(L組)或10 cm H2O(H組).于切皮前,CPB結束後1、3和6h時,抽取動脈血樣行血氣分析.計算肺泡氣-動脈血氧分壓差[D(A-a)O2]、呼吸指數(RI)、氧閤指數(OI),記錄術後留置氣管導管時間和ICU停留時間.結果 與L組比較,H組CPB結束後1、3、6h時D(A-a)O2和RI降低,OI升高,OI＜ 300 mm Hg的髮生率明顯降低(P＜0.05),術後留置氣管導管時間和ICU停留時間差異無統計學意義(P＞0.05).結論 心髒瓣膜置換手術CPB期間,靜態膨肺採用10 cm H2O壓力比5cm H2O壓力可以更好地改善術後肺瀰散功能.
목적 평개불동압력정태팽폐대체외순배(CPB)심장판막치환술후폐공능적영향.방법 택기행체외순배심장판막치환술환자60례,ASA분급Ⅱ혹Ⅲ급,체중47 ～ 78 kg,년령26 ～ 70세,채용수궤수자표법,장기분위2조(n=30).CPB기간궤계통기정지후,여지속정태팽창,호흡배로압력분별유지우,5 cmH2O(L조)혹10 cm H2O(H조).우절피전,CPB결속후1、3화6h시,추취동맥혈양행혈기분석.계산폐포기-동맥혈양분압차[D(A-a)O2]、호흡지수(RI)、양합지수(OI),기록술후류치기관도관시간화ICU정류시간.결과 여L조비교,H조CPB결속후1、3、6h시D(A-a)O2화RI강저,OI승고,OI＜ 300 mm Hg적발생솔명현강저(P＜0.05),술후류치기관도관시간화ICU정류시간차이무통계학의의(P＞0.05).결론 심장판막치환수술CPB기간,정태팽폐채용10 cm H2O압력비5cm H2O압력가이경호지개선술후폐미산공능.
Objective To evaluate the effects of pulmonary static inflation with different pressures on postoperative lung function in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients,aged 26-70 yr,weighing 47-78 kg,undergoing elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =30 each):pulmonary static inflation with 5 cm H2O group (group L) and with 10 cm H2O group (group H).In L and H groups,pulmonary static inflation was performed with the pressure maintained at 5 and 10 cm H2O,respectively,after stopping mechanical ventilation during CPB.Arterial blood samples were taken before skin incision and at 1,3 and 6 h after termination of CPB for blood gas analysis.The alveolar-arterial oxygen pressure difference (D(A-a)O2),respiratory index (RI) and oxy.genation index (OI) were calculated.The indwelling time of endotracheal tube after operation and duration of ICU stay were recorded.Results Compared with group L,D(A-a)O2 and RI were significantly decreased and OI was increased at 1,3 and 6 h after termination of CPB,the incidence of OI less than 300 mm Hg was decreased (P ＜ 0.05),and no significant change was found in the indwelling time of endotracheal tube after operation and duration of ICU stay in H group (P ＞ 0.05).Collusion Pulmonary static inflation with 10 cm H2O can better improve postoperative pulmonary diffusion function than with 5 cm H2O in patients undergoing cardiac valve replacement with CPB.
