不同氧浓度气体静态膨肺对体外循环后肺功能的影响  

Effects of pulmonary static inflation with different concentration of oxygen during cardiopulmonary bypass on lung function in patients undergoing cardiac valve replacement surgery

作　　者：戴双波[1] 齐娟[1] DAI Shuangbo;QI Juan(Department of Anesthesiology,Fujian Provincial Hospital,Fuzhou,Fujian 350001,China)

机构地区：[1]福建省立医院麻醉二科,福州350001

出　　处：《福建医药杂志》2018年第4期13-16,共4页Fujian Medical Journal

摘　　要：目的观察采用不同氧浓度气体(空气或纯氧)静态膨肺对体外循环(CPB)后肺功能及气管带管时间的影响。方法择期行体外循环瓣膜置换手术患者60例,美国麻醉学会(ASA)分级Ⅱ~Ⅲ级。采用随机数字表法,将患者随机分为两组(n=30)。CPB期间停止呼吸后,采取持续静态膨肺,呼吸环路压力维持10cm H_2 O(1cm H_2 O=0.098kPa),膨肺气体分别采用21%氧浓度(空气,L组)或100%氧浓度(纯氧,H组)。分别于切皮前、CPB后1h、3h、6h,抽取动脉血行血气分析。计算肺泡-动脉氧分压差[D(A-a)O_2]、呼吸指数(RI)、氧合指数(OI)。记录术后气管带管时间、ICU停留时间。结果与切皮前比较,两组D(A-a)O_2、RI在CPB后1h、3h、6h升高,OI在CPB后1h、3h、6h降低(P<0.05),两组各时点D(A-a)O_2、RI、OI组间比较差异无统计学意义(P>0.05),两组各时点OI<300mm Hg(1mm Hg=0.133kPa)发生病例数组间比较差异无统计学意义(P>0.05),两组术后气管带管时间和ICU停留时间组间比较差异无统计学意义(P>0.05)。结论心脏瓣膜置换手术CPB后,肺弥散功能出现下降,CPB期间静态膨肺采用空气或纯氧,对CPB后肺弥散功能的影响差异无统计学意义,也不影响术后气管带管时间和ICU停留时间。Objective To assess the effects of pulmonary static infation with different concentration of oxygen during cardiopulmonary bypass（CPB）on lung function and tracheal intubation time in patients undergoing cardiac valve replacement surgery.Methods Sixty patients undergoing cardiac valvular replacement surgery,ASA Ⅱ-Ⅲ level,were randomly divided into two groups（n=30）,pulmonary static inflation with 10 cm H2O,and with different concentration of oxygen,21%（group L）or 100%（groupH）.Arterial blood gas analysis was performed at time of surgical incision,and 1,3,6 hafter CPB weaning.The values of alveolar-arterial oxygen pressure difference[D（A-a）O2）],respiratory index[RI,D（A-a）O2/PaO2]and oxygenation index（OI,PaO2/FiO2）were calculated respectively.The tracheal intubation time and ICU stay time were recorded.Results Compared with before surgery,the PaO2,D（A-a）O2,RI were significantly lower and OI was higher at 1,3,6 h after CPB weaning both groups（P〈0.05）,but there was no significant difference between groups,and the patients of OI less than 300 mm Hg were no significant difference between groups respectively（P〈0.05）.There were no significant difference between groups in tracheal intubation time and ICU stay time（P〈0.05）.Conclusion In patients undergoing cardiac valve replacement surgery,pulmonary static infation with 10 cm H2 O,there were no significant difference between groups of static infation with 21% oxygen or 100% oxygen in pulmonary funtion,and there were no significant difference between groups in the tracheal intubation time and ICU stay time.

关 键 词：瓣膜置换手术 体外循环 肺损伤 静态膨肺 氧浓度 

分 类 号：R614.24[医药卫生—麻醉学] R654.1[医药卫生—外科学]