保护性机械通气对瓣膜置换手术后肺功能的影响  

Effects of protective mechanical ventilation on pulmonary function of patients with valve replacement

作　　者：孟毅[1] 董书强[1] 曹文峰[1] 宿华伟[1] 董逸飞[1] 

机构地区：[1]兰州军区兰州总医院心血管外科,甘肃兰州730050

出　　处：《第四军医大学学报》2008年第22期2078-2079,共2页Journal of the Fourth Military Medical University

摘　　要：目的:探讨保护性机械通气方式(PMV)对瓣膜置换手术后肺功能的影响.方法:将30例心脏瓣膜置换术患者随机分为传统通气方式组(CMV)和PMV组,每组各15例,动态测定体外循环(ECC)前、ECC后10min,3,6和12h呼吸参数、氧浓度(FiO2),氧分压(PaO2),二氧化碳分压(PaCO2),计算肺功能指标:呼吸指数(RI),氧合指数(OI),静态顺应性(Cs)和动态顺应性(Cd).结果:两组之间各时间点OI,RI,Cs和Cd差异无统计学意义(P>0.05),但ECC后3,6和12hOI值较ECC前和ECC后10min降低(P<0.01),而RI则增大(P<0.05).两组ECC后各时间点Cs均较ECC前增大(P<0.01);PMV组ECC后6,12h的Cd较ECC前增大(P<0.01).结论:PMV可能改善不了瓣膜置换术后患者肺的氧合功能,能否减轻ECC后急性肺损伤肺实质损害有待进一步研究.AIM： To study the effects of protective mechanical ventilation（PMV） on pulmonary function of patients with valve replacement. METHODS： Thirty patients subjected to valve replacement were randomly divided into 2 groups（ n = 15 ） ： PMV and conventional mechanical ventilation （CMV） groups. Parameters of ventilation, FiO2, PaO2 and PaCO2 were measured at pre- extracorporeal circulation（ECC）, 10 min, 3, 6 and 12 h post- ECC, and respiration index （ RI）, oxygenation index （ OI）, static compliance（Cs） and dynamic compliance（Cd） were calculated. RESULTS： There was no significant difference in RI, OI, Cs and Cd between the 2 groups at each time point （ P 〉 0.05 ）, but OI was lower （P〈0. 01） and RI was higher （P〈0.05） at 3, 6 and 12 h post-ECC in comparison with pre-ECC and 10 min post- ECC. Cs in the 2 groups was higher after ECC than before ECC （P〈0.01）; Cd in PMV group was higher at 6 and 12 h post- ECC than pre-EEC（P 〈0.01）. CONCLUSION： PMV can not improve pulmonary oxygenation function of patients with valve replacement. Its effects of abating post-ECC acute lung injury need further investigation.

关 键 词：保护性机械通气 呼吸功能试验 心脏瓣膜置换术 

分 类 号：R654.1[医药卫生—外科学]