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不同通气方案在体外循环下心脏手术中的应用
作者:张睿1  王喆妍1  张晓坤1  骆璇2 
单位:1. 南京大学医学院附属鼓楼医院 麻醉科, 江苏 南京 210008;
2. 南京大学医学院附属鼓楼医院 心胸外科, 江苏 南京 210008
关键词:压力通气模式 心脏手术 体外循环 呼气末正压通气 
分类号:R614.2
出版年·卷·期(页码):2018·46·第十一期(1210-1214)
摘要:

目的:探讨在体外循环下心脏手术中实施不同通气方案对患者围术期肺功能的影响,寻求体外循环下心脏手术患者术中最佳的通气方案。方法:将84例择期行心脏手术患者随机分为4组,分别是容量控制通气(V)组、压力控制通气(P)组、V+小潮气量控制通气(E)组及P+E组,观察各组患者开胸前、体外循环结束后30 min、关胸后即刻及关胸后4 h的生命体征参数、呼吸相关参数及其他临床参数。结果:在关胸后即刻P+E组较其余3组动脉血氧分压显著升高,肺泡动脉氧分压差及肺内分流率显著降低。在关胸后4 h P+E组较V组及P组动脉血氧分压显著升高,肺泡动脉氧分压差及肺内分流率显著降低;气道峰压较其余3组均显著降低,气道平均压较V组及V+E组显著降低。结论:在心脏手术中使用压力通气模式联合体外循环中给予小潮气量及呼气末正压通气可以改善患者关胸后4 h的氧合状态,减少围术期低氧血症的发生,是此种手术最适宜的通气方案。

Objective:To discuss the effect of different ventilation scheme on perioperative pulmonary function in patients undergoing cardiac surgery under cardiopulmonary bypass(CBP). Methods:Eighty-four patients undergoing elective cardiac surgery were randomized into four groups:group V, group P, group V+E and group P+E. The effects were evaluated in terms of vital signs, respiratory related parameters and other clinical parameters before operation of the chest, 30 minutes after the CPB, immediately after chest closure and 4 hours after chest closure. Results:Pmax values in P+E group were significantly lower than those in the other three groups 4 hours after chest closure. The Pmean values in P+E group were significantly lower than those in group V and group V+E. The levels of PO2 in P+E group were significantly higher than those in the other three groups immediately after chest closure. The levels of PA-aDO2 and Qs/Qt in P+E group were significantly lower than those in the other three groups immediately after chest closure. The levels of PO2 in P+E group were significantly higher than those in V group and P group 4 hours after chest closure. The levels of PA-aDO2 and Qs/Qt in P+E group were significantly lower than those in V group and P group 4 hours after chest closure. Conclusion:The use of pressure ventilation mode combined with extracorporeal circulation with small tidal volume and positive end expiratory pressure during cardiac surgery can improve the oxygenation status 4 hours after operation and reduce the occurrence of perioperative hypoxemia, which is the most appropriate ventilation scheme for this operation.

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