亲体肝移植患者术中低潮气量联合呼气末正压通气与间歇正压通气对呼吸功能的影响  

Impact of Low Tidal Volume Combined with Positive End-expiratory Pressure Ventilation vs Intermittent Positive Pressure Ventilation on Respiratory Function in Patients Undergoing Relational Orthotopic Liver Transplantation

作　　者：陈湧鸣[1] 陈杰[1] 朱凌音[2] 周姝婧[1] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]上海交通大学医学院附属仁济医院消化科,上海200127

出　　处：《医学临床研究》2013年第10期1878-1881,共4页Journal of Clinical Research

基　　金：上海市科委生物医药领域重点科技项目（104119516003）

摘　　要：【目的】比较术中低潮气量联合呼气末正压通气（PEEP）与间歇正压通气（IPPV）对亲体肝移植患者呼吸功能的影响。【方法】53例患者，根据肺功能状况分为：肺功能正常、术中IPPV组（Ⅰ组，n=23）和PEE组（Ⅱ组，n=10）；肺功能减退、术中IPPV组（Ⅲ组，n=10）和PEEP组（IV组，n=10）。观察比较各组术前、进腹后、无肝期5min、1h、再灌注后5min、术毕各时点的呼吸指标。记录术后14d内急性肺损伤（ALI）／急性呼吸窘迫综合征（ARDS）的发生率。【结果】Ⅱ组的肺血管压力指数（PVPI）在无肝期与再灌注后均低于Ⅳ组（P〈0．05）。Ⅲ纽血管外肺水（EVLW）在术前、进腹后、再灌注后以及术半时均高于Ⅰ组，在再灌注后与术毕时高于Ⅳ组（P〈0．05）。Ⅲ组的肺泡-动脉氧分压差（PAO2-PaO2）从术前到术毕全程均显著高于Ⅰ组，其中术毕时Ⅲ组的PAO2-PaO2显著高于Ⅳ组（P〈0．05）。Ⅲ组的PaO2／FiO2从术前到术毕全程均低于Ⅰ组，其中再灌注后与术毕时Ⅲ组显著低于Ⅳ组（Pd0．05）Ⅱ组的Pa（）2／Fi02则在再灌注至术毕时均高于Ⅳ组（P〈0．05）。Ⅱ组患者的ALI发生率显著低于Ⅰ组；而Ⅲ组患者ALI、ARDS的发生率均显著高于Ⅰ组与Ⅳ组（P〈0．05）。【结论】低潮气量PEEP可以改善肝移植患者手术期间的PVPI，降低EVLW和气道阻力，改善肺顺应性，可能有利于防治术中与术后ALI／ARDS的发生。[Objective] To compare the impact of low tidal volume combined with positive end-expiratory pressure（PEEP） ventilation vs intermittent positive pressure ventilation（IPPV） on respiratory function of patients undergoing relational liver transplantation.[Methods] According to lung function, 53 patients were randomly divided into normal lung function and intraoperative IPPV group （group Ⅰ, n =23）, normal lung function and PEEP group（group Ⅱ n = 10）, lung hypofunction and intraoperative IPPV group（group Ⅲ, n = 10） and lung hypofunction and PEEP group（group Ⅳ, n = 10）. Respiratory parameters of all groups before operation, after abdominal cavity, 5min and lh of anhepatic phase, 5min after reperfusion and after operation were observed and compared. The incidence of acute lung injury（ALI）/acute respiratory distress syndrome（ARDS） 14d after operation was recorded. [Results] The pulmona ry vascular pressure index（PVPI） of group Ⅱ at anhepatic phase and after reperfusion was lower than that of group Ⅳ（ P 〈0.05）. Extravascular lung water（EVLW） of group 1][ before operation, after abdominal cavity opening, reperfusion and operation was higher than that of group Ⅰ, and that after reperfusion and operation was higher than that of group Ⅳ（ P〈0. 05 ）. The alveolar-arterial oxygen partial pressure difference（PACh-PaO2 ） of group m from before operation to after operation was significantly higher than that of group Ⅰ, and that of group Ⅲ after operation was significantly higher than that of group IV （ P 〈0.05）. PaO2/FiO2 of group Ⅰ from before to after operation was lower than that of group Ⅰ, and that after reperfusion and operation was significantly lower than that of group Ⅳ （ P 〈0.05）. PaO2/FiO2 of group Ⅱ from at reperfusion to after operation was higher than that of group Ⅳ（ P 〈Q0.05）. Static lung compliance（Cst） of groupⅢ from before to after operation was significantly lower than that of group Ⅰ, but that of group

关 键 词：肝移植 正压呼吸 

分 类 号：R617[医药卫生—外科学]