低潮气量机械通气对瓣膜置换病人心肺功能影响的临床研究  

The Effect of Low Tidal Volume Ventilation on Pulmonary and Cardiac Function before and after Mitral Valve Replacement

作　　者：蔡宏伟[1] 任飞[2] 张海萍[2] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院同济医院麻醉科,湖北武汉430030 [2]中南大学湘雅医院麻醉科

出　　处：《中国医师杂志》2005年第5期586-589,共4页Journal of Chinese Physician

摘　　要：目的以心输出量和肺换气功能为指标研究低潮气量通气对瓣膜置换病人心肺功能的影响。方法30例择期行二尖瓣置换手术病人随机分成三组常规(传统)潮气量组(组Ⅰ)、低潮气量常规频率组(组Ⅱ)和低潮气量高频率组(组Ⅲ)。监测平均动脉压(MAP),放置飘浮导管监测心输出量(CO)和心指数(CI),平均肺动脉压(MPAP),肺毛细血管嵌压(PCWP),中心静脉压(CVP),体循环阻力指数(SVRI),肺循环阻力指数(PVRI)。测定动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2),以及氧合指数(PaO2/FiO2),肺泡动脉氧分压差(PA-aO2),肺内分流量(QS/QT)。结果在体外循环前(T2),常规潮气量组的心输出量(CO)低于低潮气量高频率组(P<0.05)。组II,体外循环后60min与比麻醉后体外循环前比,氧和指数(PaO2/FiO2)显著降低(P<0.05),肺泡-动脉氧分压差(PA-aO2)和肺内分流量(QS/QT)显著增加(P<0.05)。组II与组I和组III相比,在体外循环后60min(T4),氧和指数显著降低(P<0.05),肺泡-动脉氧分压差和肺内分流量显著增加(P<0.05)。结论低潮气量机械通气对循环功能无明显影响,并能保持良好通气。低潮气量常规频率通气不能减轻体外循环引起的肺换气功能损害。低潮气量高频率通气和常规潮气量通气能减轻或消除体外循环引起的早期肺换气功能损害。常规潮气量机械通气下?Objective To investigate the effects of low tidal volume ventilation on pulmonary and cardiac function before and after mitral valve replacement. Methods Thirty patients with mitral valve diseases were randomly divided into traditional tidal volume ventilation (groupⅠ), low tidal volume ventilation with conventional respiratory rate (group Ⅱ), and low tidal volume ventilation with high respiratory rate (group Ⅲ). Mean arterial pressure (MAP), cardiac output(CO), cardiac index(CI), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) were monitored. Arterial oxygen tension (PaO_2), carbon dioxide tension (PaCO_2), oxygen saturation index(PaO_2/FiO_2), alveolar-arterial PO_2 gradient (PA-aO_2), and Q_S/Q_T were measured. Results Before CPB, CO in group Ⅰ was significantly lower than that in group Ⅲ (P<0.05). In group Ⅱ PaO_2/FiO_2 significantly decreased, PA-aO_2 and Q_S/Q_T obviously increased 60 minutes after CPB compared with before CPB. 60 minutes after CPB, PaO_2/FiO_2 obviously decreased, and PA-aO_2 and Q_S/Q_T significantly increased in group II compared with groups I and III(P<0.05). Conclusion Low tidal volume ventilation could maintain normal blood gas. Traditional tidal volume ventilation decreased cardiac output.

关 键 词：低潮气量机械通气 瓣膜置换病人 临床研究 功能影响 肺泡-动脉氧分压差 动脉二氧化碳分压 肺泡动脉氧分压差 肺内分流量 体外循环后 心输出量 低潮气量通气 平均肺动脉压 阻力指数 功能损害 肺换气功能 二尖瓣置换 平均动脉压 

分 类 号：R614[医药卫生—麻醉学]