浅低温体外循环心脏不停跳心内直视手术中肺保护的临床研究  

Clinical research of lung protection in heart surgery on beating heart and mild hypothermia CBP

作　　者：莫安胜[1] 林辉[1] 何巍[2] 冯旭[2] 

机构地区：[1]广西壮族自治区人民医院心胸外科,南宁530021 [2]广西医科大学第一附属医院心胸外科

出　　处：《广西医学》2005年第6期795-798,共4页Guangxi Medical Journal

摘　　要：目的研究浅低温体外循环(CPB)心脏不停跳心内直视手术中不停辅助呼吸对肺脏的保护作用。方法将20例风湿性心脏病二尖瓣狭窄患者随机分为2组。对照组的心内手术是在中低温体外循环下进行;实验组的心内直视手术在浅低温体外循环下进行。两组病人术后送回ICU用西门子900C呼吸机辅助呼吸,潮气量设定为体重(kg)×12mL,频率为12次/min,氧饱和度为100%,采桡动脉血进行血气分析。结果停CPB后2h、3h、4h实验组与对照组在同一时点动脉血氧分压(PO2)比较差异有显著性。结论浅低温体外循环心脏跳动中、不停呼吸辅助心内直视手术可减轻肺的损伤,对肺脏有保护作用。Objective To study the protective effect of lung in open heart surgery of beating heart and mild hypothermia cardiopulmonary bypass(CPB).Methods 20 patients with chronic rheumatic mitral stenosis were randomly divided into two groups (10 patients in each group). Control group: superior vena cava (SVC) and inferior vena cava (IVC) were banded and ascending aorta was crossclamped when CBP had been established. Then cardiac standstill was achieved with perfusing cardioplegia solution and assisting respiratory was cessation. Respiratory was resumed until total drainage of bicaval of CPB had been completed.Experimental group: CBP was established as usual and heart was kept beating during mild hypothermia CBP. A part of pulmonary artery blood from right heart system, low pressure of left atrium and respiration must be maintained after SVC and IVC were banded.Sero ventilator 900C was served at both group in intensive care unite (ICU) after operation. O_2 concentration was set at 100%, tidal volume was set according to weight(kg)×12 mL, and the other ventilation modes were no different.Results At the 2 h、3 h、4 h after CPB, PO_2 of artery blood of experimental group was higher than control group (P<0.05).Conclusion Open heart surgery on beating heart and mild hypothermia CPB with keeping respiration may relieve injury.

关 键 词：肺脏保护 心脏不停跳 动脉血氧分压 

分 类 号：R542.51[医药卫生—心血管疾病]