肺复张治疗急性Stanford A型主动脉夹层术后低氧血症  

Treatment effect of lung recruitment maneuver on hypoxemia after surgery in patients with acute Stanford A aortic dissection

作　　者：刘洋[1] 唐杨烽[1] 李白翎[1] 郑艳华[1] 周炜[1] 陈常兴[1] 唐小军[1] 徐志云[1] 

机构地区：[1]第二军医大学第一附属医院胸心外科,上海200433

出　　处：《心肺血管病杂志》2014年第2期190-193,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：评价肺复张术对于改善急性Stanford A型主动脉夹层术后早期低氧血症的疗效.方法：2011年10月至2013年1月,急性Stanford A型主动脉夹层术后发生低氧血症（以术后24h内氧合指数＜ 150 mmHg为标准,1mmHg=0.133kPa）患者25例,男性20例,女性5例,年龄31～61岁,平均（46.0±9.2）岁.持续监测有创血压、经皮血氧饱和度、心率,按照理想体质量给予小潮气量肺保护通气,结合呼吸末正压（PEEP）递增法进行肺复张术.于复张前后进行动脉血气分析及监测静态肺顺应（Cs）.结果：全部患者肺复张后PaO2、PaO2/FiO2及Cs较复张前差异有统计学意义（P＜0.05）,第2次肺复张后PaO2/FiO2较第1次复张后差异有统计学意义（P＜0.05）.所有患者均无气压伤或其他严重并发症发生.结论：肺保护性通气结合肺复张策略可以有效改善急性A型主动脉夹层术后低氧血症,在最大PEEP不超过20 cmH2O（1cmH2O =0.098kPa）的情况下,肺复张是安全的且对循环影响较小.Objective：To study clinical effectiveness and possible side effects with lung recruitment on hypoxemia after surgery in patients with acute Stanford A aortic dissection in early stage.Methods：Twenty five patients with hypoxemia after surgery for acute Stanford A aortic dissection were included from October 2011 to January 2013.There were 20 male and 5 female with an average age of 46.0 years （31-61years）.Patients with oxygenation index less than 150 within first postoperative 24 hours to be included in the study.Continuous monitoring of invasive blood pressure,transcutaneous oxygen saturation,heart rate,according to ideal body weight low tidal volume were given for lung protective ventilation,and Recruitment maneuvers were conducted by stepwise rising of positive end expiratory pressure （PEEP） level.Arterial blood gas analysis （ABG） and static compliance of lung （Cs） were measured before and after applying recruitment maneuvers.Results：PaO2,PaO2/FiO2 and Cs were increased significandy after applying recruitment maneuvers in all 25 cases.PaO2/FiO2 were increased significantly after applying second recruitment maneuvers than after applying first recruitment maneuvers.All patients had no barotrauma,or other serious complications.Conclusion：Lung protective ventilation combined with lung recruitment strategy can effectively improve hypoxemia after surgery for acute type A aortic dissection.In case the maximum PEEP does not exceed 20 cmH2 O （1 cmH2 O =0.098 kPa）,lung recruitment is safe and have less impact on the haemodynamics.

关 键 词：肺复张 STANFORD A型主动脉夹层 低氧血症 术后 

分 类 号：R543[医药卫生—心血管疾病]