大容量聚明胶肽零平衡超滤对急性A型主动脉夹层患者术后肺功能的影响  

Analysis of the effect of zero equilibrium ultrafiltration with high volume polyglycopeptide on pulmonary function in type A aortic dissection surgery

作　　者：耿直[1] 任云 姚昊[1] 孙煦 GENG Zhi;REN Yun;YAO Hao;SUN Xu(The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第二附属医院心血管中心,江苏省南京市210000

出　　处：《中国心血管病研究》2022年第1期52-56,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探究急性A型主动脉夹层术中应用大剂量聚明胶肽做零平衡超滤对患者术后肺功能的影响。方法对我院2016年7月至2019年7月收治的135例急性A型主动脉夹层患者,用随机数字表法分为三组,每组45例,分别使用聚明胶肽持续进行平衡超滤(U组),平衡盐溶液持续进行平衡超滤(M组)和仅使用常规超滤进行治疗(C组),观察三组患者一般情况和手术情况,转流前(T1)、转流结束后20 min(T2)、术后2 h(T3)、术后6 h(T4)及术后12 h(T5)肺功能变化,比较不同平衡超滤置换液对术后肺功能的影响。结果三组患者体外循环后肺静态顺应性明显降低,肺泡-动脉氧分压梯度明显升高(P<0.05);三组患者术前一般情况、手术时间、体外循环时间、主动脉阻断时间和停循环时间差异无统计学意义(P>0.05);T3及T4时间点U组、M组患者肺静态顺应性及氧合指数均明显高于C组,而肺泡-动脉氧分压梯度、机械通气时间、监护室停留时间明显低于C组(P<0.05);T3和T4时间点,U组患者肺静态顺应性及氧合指数均明显高于M组,而肺泡-动脉氧分压梯度、机械通气时间、监护室停留时间明显低于M组(P<0.05)。结论急性A型主动脉夹层手术会不可避免地影响患者肺功能,应用大容量聚明胶肽做平衡超滤比平衡盐溶液更能减轻肺损伤,提高患者预后,保证生存质量。Objective To investigate the effect of zero equilibrium ultrafiltration with high-dose polygluco peptide on postoperative pulmonary function in the patients with acute type A aortic dissection.Methods 135 patients with acute type A aortic dissection treated in our hospital from July 2016 to July 2019 were equally divided into groups according to the random number table.45 patients in each group were treated with continuous balanced ultrafiltration with polygelatin peptide,continuous balanced ultrafiltration with balanced salt solution and conventional ultrafiltration only.The general conditions,surgical conditions,changes of pulmonary function before cardiopulmonary bypass(T1),20 min after cardiopulmonary bypass(T2),2 h after operation(T3),6 h after operation(T4) and 12 h after operation(T5)of the three groups were observed to compare the effects of different equilibrium ultrafiltration replacement solutions on the pulmonary function in the patients with acute type A aortic dissection.Results After cardiopulmonary bypass,pulmonary static compliance decreased significantly and the alveolar arterial oxygen partial pressure gradient increased significantly(P<0.05).There was no significant difference in preoperative general condition,operation time,cardiopulmonary bypass time,aortic occlusion time and circulatory arrest time among the three groups(P> 0.05).At T3 and T4 time points,the pulmonary static compliance and oxygenation index in the group u and group m were significantly higher than those in the group c,while the alveolar arterial oxygen partial pressure gradient,mechanical ventilation time and ICU stay time were significantly lower than those in the group c(P<0.05).At T3 and T4 time points,the pulmonary static compliance and oxygenation index in the group u were significantly higher than those in the group m,while the alveolar arterial oxygen partial pressure gradient,mechanical ventilation time and ICU stay time in the group u were significantly lower than those in group m(P<0.05).Conclusion The operation o

关 键 词：大容量聚明胶肽 零平衡超滤 急性A型主动脉夹层 肺功能 

分 类 号：R543.1[医药卫生—心血管疾病]