Stanford A型主动脉夹层围术期拔管时机的选择  

The timing of extubation following the operation of Stanford type A aortic dissection

作　　者：杨毅 刘楠 侯晓彤 金祺 王守凤 赵欣艳 鲁旭然 孙立忠 朱俊明 YANG Yi;LIU Nan;HOU Xiao-tong;JIN Qi;WANG Shou-feng;ZHAO Xin-yan;LU Xu-ran;SUN Li-zhong;ZHU Jun-ming(Department of Cardiovascular Surgery, Beijing Aortic Disease Center,Center for Cardiac Intensive Care,Beijing 100029, China;Beijing Anzhen Hospital, Capital Medical University, Beijing Institute o f Heart Lung and Blood Vessel Diseases, Beijing 100029, China)

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疾病研究所心外科危重症中心,北京市100029 [2]北京市大血管疾病诊疗研究中心心脏外科

出　　处：《中国心血管病研究》2019年第9期778-782,共5页Chinese Journal of Cardiovascular Research

基　　金：国家卫生和计划生育委员会-公益性行业科研专项项目(201402009);北京市科技重大专项课题(Z171100001017083);国家科技支撑计划项目(2015BAI12B03).

摘　　要：目的 研究StanfordA型主动脉夹层术后患者,清醒肌力恢复即拔除气管插管与常规术后第一日清晨拔管后,对呼吸与循环系统的影响.方法 2018年9月1日至2019年4月1日,将北京安贞医院心脏外科因Stanford A型主动脉夹层入院手术,术后符合纳排标准的40例患者采用简化随机法分为试验组和对照组,每组20例[年龄(47.7±13.4)岁比(51.3±12.7)岁,P>0.05;男性65.0%比70.0%,P>0.05].试验组为清醒肌力恢复即拔管,对照组为按常规处理术后第一日清晨拔除气管插管,观察分析两组患者的一般情况、机械通气时间、拔管后呼吸循环系统情况、呼吸系统并发症、监护室(ICU)时间及住院时间等指标的变化.结果 试验组机械通气(mechanical ventilation,MV)时间较对照组明显缩短[(6.9±4.3)h比(15.2±6.9)h,P<0.05],ICU时间也有所减少[(13.4±5.1)h比(21.5±7.0)h,P<0.05],拔管后两组氧合指数(PaO2/FiO2)无明显差异,但试验组动脉二氧化碳分压(PaCO2)于拔管后6h有所升高[(48.6±23.7)mm Hg比(40.1±20.4)mm Hg,P<0.05],后期逐渐下降;循环指标如心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、左心室射血分数(left ventricular ejection fraction,LVEF)等无明显差异;拔管后呼吸系统并发症发生率无明显差异.结论 对于StanfordA型主动脉夹层围术期患者,术后根据病情于清醒和肌力恢复后及时拔除气管插管,较传统于术后第一日清晨拔管,可明显缩短呼吸机辅助机械通气时间及ICU时间,但患者于拔管后早期PaCO2可短暂升高,循环系统指标及呼吸系统并发症两组无明显差异.Objective To investigate the effects o f extubation after recovery of anesthesia at once and following routine treatment which remove the tube until the next morning on the circulatory and respiratory in the patient, after the operation of Stanford type A aortic dissection. Methods 40 patients recovering from the Stanford type A aortic dissection operation in the Center for Cardiac Intensive Care, Beijing Anzhen Hospital between September 1, 2018 to April 1, 2019 and meeting the inclusion criterion after surgery, were included. The patients were random divided into experimental group and control group, each group contained 20 patients [ Age (47.7± 13.4)years vs.(51.3±12.7)years, P >0.05;Male 65.0% vs. 70.0%, P>0.05]. The experimental group was extubation immediately after awaking and the muscle strength was restored, while the control group was extubation in the morning o f the first day after operation. The changes of general condition, mechanical ventilation time, respiratory and circulatory system, respiratory system complications, ICU time and hospitalization time were observed and analyzed. Results Compared with the control group, the duration of mechanical ventilation in the experimental group was significantly shorter [(6.9±4.3)h vs.( 15.2±6.9)h, P<0.05] and the ICU time was also shorter[( 13.4±5.1 )h vs.(21.5土7 .0 )h ,P< 0 .0 5 ], but PaCO2 in the experimental group increased at 6 hours after extubation [(48.6±23.7) mm Hg vs.(40.1 ±20.4) mm H g,P<0.05] and then decreased gradually. Circulating parameters such as heart rate ( H R ), mean arterial pressure ( M AP) and left ventricular ejection fraction ( LVEF) were not significantly different between two groups. There was no significant difference in the incidence of respiratory complications after extubation. Conclusion For patients with Stanford type A aortic dissection after operation, tracheal intubation can be removed in time according to the patient's condition after awakening and muscle strength recovery, which can significantly shorten the

关 键 词：STANFORD A型主动脉夹层 拔管时机 机械通气时间 监护室时间 

分 类 号：R654.2[医药卫生—外科学]