|
| 肢体远隔缺血预处理对心肺转流心脏瓣膜置换术患者肺功能的影响 |
| Effect of limb remote ischaemic preconditioning on pulmonary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass |
| |
| DOI：10.12089/jca.2018.04.009 |
| 中文关键词: 远隔缺血预处理 心脏瓣膜置换术 心肺转流 肺功能 |
| 英文关键词: Remote ischemic preconditioning Cardiac valve replacement surgery Cardiopulmonary bypass Pulmonary function |
| 基金项目: |
|
| 摘要点击次数: 3141 |
| 全文下载次数: 1041 |
| 中文摘要: |
| 目的 评价肢体远隔缺血预处理(remote ischemic preconditioning,RIPC)对心肺转流(cardiopulmonary bypass,CPB)心脏瓣膜置换术患者肺功能的影响。方法 择期在CPB下行心脏瓣膜置换术患者70例,男32例,女38例,年龄18～70岁,体重45～90 kg,ASA Ⅱ或Ⅲ级,采用随机数字表法将患者分为两组,每组35例。R组于气管插管后10 min采用测压袖带在患者右上肢上臂,给予3个循环的5 min缺血(袖带充气,压力≥200 mm Hg)及5 min再灌注(袖带放气至0 mm Hg)处理。C组将袖带绑于患者右上肢,但不进行充气及放气操作。分别于气管插管后10 min(T0)、主动脉开放后1 h(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)采集桡动脉血样,进行血气分析,计算氧合指数(PaO2/FiO2)和肺泡动脉血氧分压差(A-aDO2),肺动态顺应性(Cd)和肺静态顺应性(Cs)。记录出院时肺部不良事件情况。结果 与T0时比较，T1～T4时两组PaO2/FiO2明显降低，T2～T4时A-aDO2明显降低，T3时C组Cs、Cd明显升高，T2、T3时R组Cs、Cd明显升高（P＜0.05）。与C组比较,T2、T3时R组Cs、Cd明显提高,T0～T4时PaO2/FiO2、A-aDO2两组差异无统计学意义。与C组比较，R组肺部不良事件发生率明显降低（P＜0.05）。结论 肢体远隔缺血预处理能够改善心脏瓣膜置换术患者的肺顺应性,减少术后肺部不良事件的发生。 |
| 英文摘要: |
| Objective To evaluate the effect of limb remote ischaemic preconditioning on pulmonary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass. Methods Seventy patients, 32 males and 38 females, aged 18-70 years, weighing 45-90 kg, ASA physical status Ⅱ or Ⅲ, scheduled for elective cardiac valve replacement surgery with cardiopulmonary bypass, were divided into 2 groups using a random number table, 35 in each group. Patients in group R received three cycles of right upper-limb 5 min ischemia (blood-pressure cuff inflation to ≥ 200 mm Hg) and 5 min reperfusion (blood-pressure cuff deflation to 0 mm Hg) at 10 min after intubation. In group C, the cuff was placed around the arm but not inflated. At 10 min after intubation (T0), at 1 h after aortic declamping (T1) and at 6 h (T2), 12 h (T3), 24 h (T4) after surgery, arterial blood was sampled to conduct gas analysis, PaO2/FiO2 ratio and alveolar-arterial oxygen gradient (A-aDO2) were calculated, and the dynamic lung compliance (Cd) and static lung compliance (Cs) were also recorded. The occurrence of pulmonary adverse events was recorded until discharge. Results Compared with T0, PaO2/FiO2 was decreased in the two groups at T1-T4, A-aDO2 was decreased at T2-T4, Cs and Cd were increased in group C at T3, and were increased in group R at T2, T3 (P＜0.05). Compared with group C, the Cs and Cd at T2, T3 were increased in group R. There were no significant differences between the two groups in the PaO2/FiO2, A-aDO2 at T0-T4. The occurrence of the pulmonary adverse events was decreased significantly in group R than in group C (P＜0.05). The occurrence of pulmonary adverse events was declined significantly in group R than in group C (P＜0.05). Conclusion Limb remote ischemic preconditioning can improve the lung compliance and reduce the occurrence of the pulmonary adverse events in patients undergoing cardiac valve replacement surgery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
