上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (7): 843-.

• 论著（临床研究） • 上一篇    下一篇

体外循环期间不同通气模式对心脏手术患者肺功能的影响

沈赛娥1,2, 王英伟2   

  1. 1.温州医学院, 温州 310033；2.上海交通大学 医学院新华医院麻醉科, 上海 200092
  • 出版日期:2010-07-25 发布日期:2010-07-26
  • 作者简介:沈赛娥(1971—), 女, 副主任医师, 硕士生；电子信箱: ej8710@sina.com。

Effects of different ventilation modes during cardiopulmonary bypass on pulmonary function after cardiac surgery

SHEN Sai-e1,2, WANG Ying-wei2   

  1. 1.Wenzhou Medical College, Wenzhou310033, China；2.Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
  • Online:2010-07-25 Published:2010-07-26

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摘要：

目的 探讨体外循环期间实施不同的通气模式对心脏手术患者肺功能的影响。方法 以40例心脏瓣膜置换择期手术患者作为研究对象。根据患者体外循环期间接受的不同通气模式分为组Ⅰ（潮气量和呼气末气道正压均为0）、组Ⅱ（潮气量为5 mL/kg，呼气末气道正压为0）、组Ⅲ（潮气量为0，呼气末气道正压为10 cmH2O）和组Ⅳ（潮气量为5 mL/kg，呼气末气道正压为10 cmH2O），每组10例。记录胸骨锯开前、体外循环结束即刻、关胸后及体外循环后4 h的肺功能和血流动力学相关参数，包括动脉氧分压（PaO2）、肺泡动脉氧分压差（AaDO2）、肺内分流率（Qs/Qt）、吸气峰压(PIP)、死腔容积与潮气量比（Vd/Vt）、肺动态顺应性(Cdyn)和心脏指数（CI）等，并进行统计学分析和比较。结果 与胸骨锯开前比较，体外循环后4 h时间点各组PaO2显著降低，CI显著升高（P<0.05）；组Ⅰ和组Ⅱ的Qs/Qt、PIP、Vd/Vt显著升高，而Cdyn明显降低（P<0.05）；组Ⅲ和组Ⅳ的AaDO2显著降低（P<0.05）。在体外循环后4 h时间点，与组Ⅰ和组Ⅱ比较，组Ⅲ、组Ⅳ的PaO2和Cdyn明显增高（P<0.05），而AaDO2、Qs/Qt 、Vd/Vt显著降低（P<0.05)。结论 与单纯机械通气相比，心脏手术患者体外循环期间予以持续气道正压可明显减轻患者的肺功能损伤程度。

关键词: 体外循环, 机械通气, 持续气道正压, 肺功能

Abstract:

Objective To investigate the effects of different ventilation modes during cardiopulmonary bypass on pulmonary function after cardiac surgery. Methods Forty patients undergoing surgery for aortic valve diseases were selected, and were randomly divided into groupⅠ(0 of tidal volume and 0 of positive end expiratory pressure), groupⅡ (5 mL/kg of tidal volume and 0 of positive end expiratory pressure), group Ⅲ (0 of tidal volume and 10 cmH2O of positive end expiratory pressure) and group Ⅳ(5 mL/kg of tidal volume and 10 cmH2O of positive end expiratory pressure) according to different ventilation modes during cardiopulmonary bypass, with 10 patients in each group. Pulmonary function and hemodynamics-related parameters were recorded before chest opening, after weaning from bypass, after chest closure and 4 h after cardiopulmonary bypass, including arterial oxygen pressure(PaO2), alveolo-arterial oxygen partial pressure difference (AaDO2), intrapulmonary shunt (Qs/Qt), peak inspiratory pressure (PIP), ratio of volume of dead space to tidal volume(Vd/Vt), lung dynamic compliance (Cdyn) and cardiac index(CI), and statistical analysis and comparison were conducted. Results Compared with parameters before chest opening, PaO2 significantly decreased and CI significantly increased 4 h after cardiopulmonary bypass in each group (P<0.05), Qs/Qt, PIP and Vd/Vt significantly increased and Cdyn significantly decreased in groupⅠand groupⅡ(P<0.05), AaDO2 significantly decreased in group Ⅲ and group Ⅳ (P<0.05). Compared with parameters in groupⅠand groupⅡ, PaO2 and Cdyn significantly increased, and AaDO2, Qs/Qt, PIP and Vd/Vt significantly decreased 4 h after cardiopulmonary bypass in group Ⅲ and group Ⅳ (P<0.05). Conclusion Compared with single mechanical ventilation, continuous positive airway pressure during cardiopulmonary bypass may significantly mitigate lung injury after cardiac surgery.

Key words: cardiopulmonary bypass, mechanical ventilation, continuous positive airway pressure, pulmonary function