急性Stanford A型主动脉夹层手术体外循环期间氙气静态膨肺对肺功能的影响  

Effects of lung static inflation with Xenon on perioperative lung function in patients undergoing acute stanford A aortic dissection surgery

作　　者：马志高[1] 侯思雨[1] 王岳锋[1] 马月华[1] 王嵘[1] 金沐[1] 程卫平[1] 卢家凯[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2016年第3期209-212,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科学技术委员会-首都临床特色应用研究(项目编号:Z141107002514135);北京市科学技术委员会-首都临床特色应用研究与成果推广(Z151100004015133);首都卫生发展科研专项项目(首发2011-2006-03);国家卫生和计划生育委员会-公益性行业科研专项项目(201402009)

摘　　要：目的:通过Stannfod A型夹层手术体外循环(CPB)期间给予50%氙气静态膨肺,观察围术期肺功能指标的变化,评价氙气对肺功能的保护作用。方法:发病14d以内的急性Stanford A型夹层患者100例,随机分成对照组(CPB期间50%氧气与50%氮气静态膨肺,气道压5cm H2O,1cm H2O=0.098k Pa)和氙气组(CPB期间50%氙气与50%氧气静态膨肺,气道压5cm H2O),每组各50例。分别于诱导后(T0),术后10min(T1),术后6h(T2)及术后24h(T3)行血气分析,并于T0、T1、T2时刻计算氧合指数(OI)、呼吸指数(RI)及肺动、静态顺应性。结果:与T0相比,两组患者T1及T2时间点OI明显下降,RI明显升高。T1时间点氙气组OI下降较少(18.8%vs.33.8%,P=0.021),RI上升较低(34.5%vs.130%,P=0.000),T2时间点各肺功能值比较差异均无统计学意义。结论:Stanford A型夹层患者术后均发生肺功能受损,CPB期间50%氙气静态膨肺可改善术后即刻的肺功能。Objective： To assess the effects of pulmonary static inflation with 50% Xenon during CPB on lung function in acute Stanford A aortic dissection patients undergoing emergency surgery by observing the perioperative changes of indices of pulmonary function. Methods： One hundred patients with acute Stanford A aortic dissection（ onset≤14days） were randomly assigned to control group（ pulmonary static inflation with 50%O2and 50% N2,n = 50） and Xenon group（ pulmonary static inflation with 50% O2 and 50% Xenon,n =50）. The pressure of pulmonary static inflation was maintained at 5 cm H2O（ 1cm H2 O = 0. 098 k Pa） in both group. Arterial blood gas analysis was performed after anesthesia induction（ T0）,10min（ T1） 、6 h（ T2） and24h（ T3） after surgery,respiratory index（ RI） 、oxygenation index（ OI） 、dynamic pulmonary compliance（ Cdyn） and static pulmonary compliance（ Cst） were calculated at T0、T1、T2respectively. Results： Compared with the baseline（ T0）,OI decreased and RI increased obviously at T1 and T2in both groups. Compared with control group,OI decreased less（ 18. 8% vs. 33. 8%,P = 0. 021） and RI increased less（ 34. 5% vs. 130%,P = 0. 000） in Xenon group at T1,The indices of T2 have no difference between groups. Conclusion： Lung injury occurs in all acute Stanford A aortic dissection patients undergoing emergency surgery. Lung static inflation with 50% Xenon can improve immediate pulmonary function after surgery.

关 键 词：主动脉夹层 氙气 肺损伤 

分 类 号：R54[医药卫生—心血管疾病]