肺开放策略对体外循环术后呼吸功能的影响  

Effects of open lung concept on respiratory function after cardiopulmonary bypass

作　　者：高增栋[1] 仲崇俊[2] 陆晨希[2] 薛群[2] 李峰[1] 姚小平[3] 刘麟[3] 

机构地区：[1]江苏省南通市第一人民医院南通大学第二附属医院急诊中心,南通226001 [2]江苏省南通市第一人民医院心胸外科,南通226001 [3]江苏省南通市第一人民医院麻醉科,南通226001

出　　处：《南通大学学报（医学版）》2007年第5期332-334,共3页Journal of Nantong University(Medical sciences)

基　　金：南通市社会发展计划资助项目(S2006006)

摘　　要：目的:研究肺开放策略(OLC)对体外循环(CPB)手术后呼吸功能的影响。方法:选择24例心内直视手术患者,随机分成常规机械通气组(CMV)、早期肺开放组(EOL)、晚期肺开放组(LOL),EOL组在气管插管后实施肺开放策略,LOL组到达ICU后30 min实施肺开放策略;分别于术前、CPB后及到ICU后120、240、360 min记录各项呼吸指标:吸氧浓度、气道峰压、实际潮气量、呼气末气道正压(PEEP)等并同时测动脉血气,计算氧合指数和动态肺顺应性。结果:CMV组CPB后及到ICU后120、240 min肺动态顺应性较术前明显下降(P<0.01),氧合指数CPB后各时段较术前明显下降(P<0.01);EOL组肺动态顺应性CPB后未见下降;LOL组经实施肺开放后肺动态顺应性、氧合指数逐渐上升,但在到ICU 120 min前肺动态顺应性仍低于EOL组(P<0.05);维持肺开放的最低PEEP LOL组高于EOL组(P<0.01)。结论:OLC可减轻CPB相关的肺损伤,早期实施OLC优于晚期实施OLC。Objective：To explore the effects of open lung concept （OLC） on pulmonary function in patients who underwent cardio-pulmonary bypass （CPB）. Methods： 24 patients underwent cardiac surgery with CPB were divided randomly into conventional mechanical ventilation group （CMV）, OLC started directly after intubation （early open lung group, EOL） and OLC started 30min after arrival in the intensive care unit （late open lung group,LOL）. FiO2, peak airway pressure,tidal volume, and positive end-expiratory pressure （PEEP） were measured.Arterial blood was taken for gas analysis at the same time and static pulmonary compliance（Cst）, oxygen index（OI） were calculated before operation, after CPB and 120 min, 240 min, and 360 min after arrival in ICU. Results： Compared with these before operation and from the end of CPB to 240 min after arrival in ICU, Cdyn was significantly lower in CMV group （P〈0.01） and OI was lower till 360 min after arrival in ICU（P〈0.01）. No reducing of Cdyn was found in EOL group after CPB.In LOL group,Cdyn and OI began to increase after OLC was applied but Cdyn was lower than that of EOL group till 120 min after arrival in ICU （P〈0.05） and the PEEP needed to keep the lung open was higher,which was 12±0.71 cmH20 vs 10±0 cmH20 （P〈0.01）. Conclusions： OLC ventilation leads to an attenuated lung injury after cardiac surgery.Early application of the OLC has a more pronounced effect compared with late application of this ventilation strategy.

关 键 词：体外循环 肺开放策略 呼吸功能 

分 类 号：R654.12[医药卫生—外科学]