|
| 个体化呼气末正压对心肺转流下瓣膜手术患者肺功能的影响 |
| Effect of individualized postive end-expiratory pressure on pulmonary function in patients with value surgery under cardiopulmonary bypass |
| |
| DOI：10.12089/jca.2021.08.008 |
| 中文关键词: 个体化呼气末正压 心脏手术 肺超声 术后肺部并发症 |
| 英文关键词: Individualized postive end-expiratory pressure Cardiac surgery Lung ultrasound Postoperative lung complication |
| 基金项目: |
| 作者 | 单位 | E-mail | | 王悠然 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 葛亚力 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | ge_yl@163.com | | 魏海燕 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 施韬 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 苏中宏 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 王晓亮 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 史宏伟 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | |
|
| 摘要点击次数: 1895 |
| 全文下载次数: 602 |
| 中文摘要: |
目的 探讨心脏瓣膜术中早期应用个体化呼气末正压（PEEP）对患者肺功能的影响。
方法 选择2019年7—10月择期行瓣膜手术的患者33例，男11例，女22例，年龄40～70岁，BMI 18～26 kg/m2，ASA Ⅱ或Ⅲ级，心功能Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：对照组（C组，n=17）和个体化PEEP组（P组，n=16），两组术中麻醉维持为全凭静脉麻醉。停机后P组采用阶梯PEEP法滴定适宜的PEEP，并维持至手术结束，C组设置固定PEEP 4 cmH2O。记录手术前（T0）、肺复张前（T1）、肺复张后40 min（T2）、术后2 h（T3）、术后24 h（T4）的氧合指数（PaO2/FiO2），T0—T2时的HR、MAP、CVP，T 1—3时的肺动态顺应性（Cdyn）。使用经胸超声检查并记录T0、T2—T4时的肺超声评分（LUS评分）和术后肺部并发症的发生情况。
结果 与T1时比较，T2、T3时P组PaO2/FiO2和Cdyn明显升高（P<0.05）。与C组比较，T2时P组PaO2/FiO2和Cdyn均明显升高（P<0.05），T2—T4时P组LUS评分明显降低（P<0.05），P组术后肺水肿的发生率明显降低（P<0.05）。两组其余术后肺部并发症发生率差异无统计学意义。
结论 在心脏瓣膜手术心肺转流停机后早期应用个体化PEEP具有肺保护作用。 |
| 英文摘要: |
Objective To explore the lung protective effect of early application of individualized postive end-expiratory pressure (PEEP) in heart valve surgery.
Methods A total of 33 patients undergoing valvular surgery during July to October 2019, 11 males and 22 females, aged 40-70 years, BMI 18-26 kg/m2, ASA physical status Ⅱ or Ⅲ, NYHA cardiac function grade Ⅱ or Ⅲ, were divided into two groups by random number table method: control group (group C, n = 17) and the individualized PEEP group (group P, n = 16), and the intraoperative anesthesia was maintained by intravenous anesthesia in the two groups. After the cardiopulmonary bypass, the appropriate PEEP was titrated by the step PEEP method in group P and maintained until the end of the operation, and the fixed PEEP 4 cmH2O was set in group C. The oxygenation index (PaO2/FiO2) before surgery (T0), before lung recruitment (T1), 40 minutes after lung recruitment (T2), 2 hours after surgery (T3), 24 hours after surgery (T4) were recorded. The HR, MAP, CVP at T0-T2 and dynamic lung compliance (Cdyn) at T1-T3 were recorded. LUS score by transthoracic ultrasound at T0, T2-T4 and postoperative pulmanary complications (PPCs) were also recorded.
Results Compared with T1, the PaO2/FiO2 and Cdyn of group P at T2 and T3 were lower (P<0.05). The PaO2/FiO2 and Cdyn of group P at T2 were significantly higher than those of group C (P < 0.05). The LUS scores of group P at T2-T4 were lower than those of group C (P < 0.05). The incidence of postoperative pulmonary edema in group P was significantly lower than that in group C (P < 0.05). There was no statistical significance in the incidence of other PPCs between the two groups.
Conclusion Early application of personalized PEEP after cardiopulmonary bypass during cardiac valve surgery has a protective effect on lung function. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
