肺动脉收缩压与二尖瓣置换术后早期肺损伤的相关性  

Correlation between systolic pulmonary arterial pressure and early postoperative acute lung injury in patients undergoing mechanical mitral valve replacement

作　　者：宋晓蓉[1] 姜波[1] 严中亚[1] 卢中[1] 朱正艳[1] 李华宝[1] 

机构地区：[1]安徽省立医院安徽省心血管病研究所,合肥230001

出　　处：《山东医药》2013年第23期6-9,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81071376)

摘　　要：目的探讨术前肺动脉收缩压(SPAP)与二尖瓣狭窄(MS)患者行二尖瓣膜置换术(MVR)患者术后早期肺损伤的关系。方法选择我院收治的风湿性MS患者236例,均行二尖瓣机械置换术,记录术前、手术结束时、入ICU时动脉血氧分压、二氧化碳分压、吸入氧浓度,计算肺泡—动脉血氧分压差(A-aDO2)、氧合指数(OI);ANO-VA分析术后早期肺通气及氧合功能变化,线性相关分析法分析术前SPAP与MVR术后A-aDO2、OI变化程度的相关性。结果与术前及手术结束时比较,入ICU时A-aDO2水平升高、OI水平降低(P<0.05或0.01);术前SPAP高低与术后OI降低呈度呈直线相关关系(r=0.182 1,95%CI为0.039 18～0.317 70,P=0.012 9;r=0.159 8,95%CI为0.013 83～0.299 10,P=0.032 1)。结论术前SPAP程度与MVR术后肺功能受损程度密切相关,OI的变化可作为一项敏感指标为MVR后急性肺损伤的早期诊断和治疗提供依据。Objective To investigate whether an elevated systolic pulmonary arterial pressure （SPAP） is associated with acute lung injury of early post-operation in patients undergoing mechanical mitral valve replacement （MVR） for rheu- matic mitral stenosis （MS）. Methods Clinic data were retrospectively analyzed from 236 patients with rheumatic mitral stenosis undergoing mitral valve replacement operation in Anhui Provincial Hospital during January 2000 to December 2012. The general data of patients, pre-operation echocardiogram data, PaO2, PaCO2 and FiO2 were recorded before and at the end of the operation, at the time of admission to ICU immediately. A-aDO2 （ alveolar-arterial oxygen pressure differ- ence, A-aDO2 ） and the oxygenation index （OI） were calculated accordingly. The differences of pulmonary gas exchange and oxygenation were analyzed using ANOVA. The correlation of preoperative SPAP with the changes in A-aDO2 and OI af- ter the MVR was analyzed using linear correlation. Results The levels of A-aDO2 in patients undergoing MVR at the time of the admission to ICU were elevated compared with those of pre-operation or at the end of the operation, while that of OI was decreased （P 〈 0.05 or P 〈 0. O1 ）. The systolic pulmonary arterial pressures showed linear correlation with the degree of decrease of OI at the end of the operation and the admission to ICU immediately （ r = 0. 182 1, 95% CI： O. 039 18- 0. 317 70, P =0.012 9; r =0. 159 8, 95% CI： 0. 013 83-0. 299 10, P = 0. 032 1）. Conclusions The pulmonary gas exchange and oxygenation were significantly deteriorated in patients undergoing mechanical MVR for rheumatic mitral steno- sis in the early post-operation. The deteriorations were linearly correlated with the systolic pulmonary arterial pressures be- fore the operation. The OI might be a sensitive indicator of the diagnosis and treatment for acute lung injury in early post- operation of MVR patients.

关 键 词：二尖瓣狭窄 体外循环 肺动脉高压 急性肺损伤 

分 类 号：R655.3[医药卫生—外科学] R654.1[医药卫生—临床医学]