不同浓度七氟醚对静态膨肺患者心肺转流后肺气体交换的影响  

Effects of pulmonary static inflation with different concentration of sevoflurane during cardiopulmonary bypass on gas exchange 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,College of Fujian Provincial Hospi-tal,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院麻醉科,福州市350001

出　　处：《临床麻醉学杂志》2018年第10期945-948,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价不同浓度七氟醚静态膨肺对心肺转流(cardiopulmonary bypass,CPB)后肺气体交换及术后气管留管时间的影响。方法择期行CPB下瓣膜置换手术患者75例,男39例,女36例,年龄22～65岁,ASAⅡ或Ⅲ级。采用随机数字表法将患者随机分为三组:每组25例。CPB期间停止呼吸后,予持续静态膨胀,呼吸环路压力维持10cmH2O,膨肺气体采用空气,分别复合吸入1%七氟醚(L组)或2%七氟醚(H组),对照组(N组)不复合吸入七氟醚。分别于切皮前、CPB停机后1、3、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)和氧合指数(OI)。记录术后气管留管时间和ICU留观时间。结果与切皮前比较,CPB停机后1、3、6h三组D(A-a)O_2、RI明显升高(P<0.05);CPB停机后1h三组OI明显降低(P<0.05)。三组不同时点D(A-a)O_2、RI和OI差异无统计学意义。三组CPB停机后1、3、6h发生OI<300mmHg的比例、术后气管留管时间和ICU留观时间差异无统计学意义。结论心脏瓣膜置换手术CPB期间,静态膨肺采用10cmH2O压力,复合吸入1%或2%浓度七氟醚,与单纯静态膨肺比较,不能进一步改善CPB后患者肺气体交换,不影响术后气管留管时间和ICU留观时间。Objective To assess the effects of pulmonary static infation with different concentration of sevoflurane during cardiopulmonary bypass（CPB）on lung function and tracheal intubation time in patients undergoing cardiac valve replacement surgery.Methods Seventy-five patients undergoing cardiac valvular replace surgery,39 males and 36 females,aged 22 to 65 years,falling into ASA physical statusⅡ orⅢlevel,were randomly divided into three groups（n=25）,pulmonary static inflation with 10 cmH2 O,and inhaled 1%sevoflurane（group L）,2% sevoflurane（group H）or none（group N）.Arterial blood gas analysis was performed at time of surgical incision,and 1,3,6 h after 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 D（A-a）O2,RI were significantly lower and OI was higher at 1,3,6 hafter CPB weaning in all three groups（P〈0.05）,but there was no statistically significant difference among the groups.There were no significant difference among the groups in the occurrence of OI less than 300 mmHg,tracheal intubation time and ICU stay time.Conclusion In patients undergoing cardiac valve replacement surgery,pulmonary static infation with 10 cmH2 O during CPB,inhaled 1%sevoflurane or 2%sevoflurane do not improve postoperative pulmonary gas exchange function.

关 键 词：瓣膜置换手术 心肺转流 肺损伤 静态膨肺 七氟醚 

分 类 号：R614[医药卫生—麻醉学]