CAJ | 학술논문

目的评价术后早期肺复张(LRM)对非体外循环冠状动脉旁路移植术(OPCABG)病人肺氧合功能的影响.方法择期行OPCABG病人126例,性别不限,年龄44 ～ 70岁,NYHA心功能分级Ⅱ或Ⅲ级,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组(n=63),对照组(C组)术后常规机械通气,LRM组术后在常规机械通气的基础上,分别于术后1、2h采用压力控制法进行LRM,支持压力和呼气末正压均为20 cmH2O,气道峰压上限40 cmH2O,维持30 s后调回原机械通气模式.分别于术毕、术后3h及停止机械通气前即刻采集桡动脉血样,进行血气分析,计算氧合指数,并记录术后低氧血症、肺不张、肺部感染、延迟拔除气管导管及监护室停留时间延长的发生情况和机械通气时间.结果 LRM组无因血流动力学不稳定而中止操作的病人.与C组比较,LRM组术后3h及停止机械通气前即刻时氧合指数升高,术后低氧血症、肺不张、肺部感染和延迟拔除气管导管的发生率降低,术后机械通气时间缩短(P ＜0.05或0.01),监护室停留时间延长发生率差异无统计学意义(P＞0.05).结论术后早期LRM可改善OPCABG病人肺氧合功能.
목적 평개술후조기폐복장(LRM)대비체외순배관상동맥방로이식술(OPCABG)병인폐양합공능적영향.방법 택기행OPCABG병인126례,성별불한,년령44 ～ 70세,NYHA심공능분급Ⅱ혹Ⅲ급,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장기분위2조(n=63),대조조(C조)술후상규궤계통기,LRM조술후재상규궤계통기적기출상,분별우술후1、2h채용압력공제법진행LRM,지지압력화호기말정압균위20 cmH2O,기도봉압상한40 cmH2O,유지30 s후조회원궤계통기모식.분별우술필、술후3h급정지궤계통기전즉각채집뇨동맥혈양,진행혈기분석,계산양합지수,병기록술후저양혈증、폐불장、폐부감염、연지발제기관도관급감호실정류시간연장적발생정황화궤계통기시간.결과 LRM조무인혈류동역학불은정이중지조작적병인.여C조비교,LRM조술후3h급정지궤계통기전즉각시양합지수승고,술후저양혈증、폐불장、폐부감염화연지발제기관도관적발생솔강저,술후궤계통기시간축단(P ＜0.05혹0.01),감호실정류시간연장발생솔차이무통계학의의(P＞0.05).결론 술후조기LRM가개선OPCABG병인폐양합공능.
Objective To evaluate the effects of early postoperative lung alveolar recruitment (LRM) on pulmonary oxygenation in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred and twenty-six ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 44-70 yr,of NYHA class Ⅱ or Ⅲ patients,scheduled for elective OPCABG,were randomly allocated into 2 groups (n =63 each):control group (group C) and LRM group.In group LRM,LRM was performed using pressure control method at 1 and 2 h after operation based on conventional mechanical ventilation.Both distending pressure and positive end-expiratory pressure were 20 cmH2O.Peak airway pressure was limited to 40 cmH2O and maintained at this level for 30 s,and then the original mode of ventilation was restored.At the end of operation,at 3 h alter operation and immediately after weaning from mechanical ventilation,blood samples were collected from the radial artery for blood gas analysis and oxygenation index was calculated.The development of postoperative hypoxemia,atelectasis,pulmonary infection,delayed removal of endotracheal tubes,and prolonged duration of intensive care unit stay,and ventilation time were recorded.Results LRM was stopped in no patients for unstable hemodynamics.Compared with group C,oxygenation index was significantly increased at 3 h after operation and immediately after weaning from mechanical ventilation,the incidence of postoperative hypoxemia,atelectasis,pulmonary infection,and delayed removal of endotracheal tubes was significantly decreased,the ventilation time was shortened,and no significant change was found in the incidence of prolonged duration of intensive care unit stay in LRM group.Conclusion Early postoperative LRM can improve pulmonary oxygenation in patients undergoing OPCABG.