资源描述:
《肺开放策略对体外循环术后呼吸功能影响.doc》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、肺开放策略对体外循环术后呼吸功能影响作者:高增栋,仲崇俊,陆晨希,薛群,李峰,姚小平,刘麟【摘要】目的:研究肺开放策略(OLC)对体外循环(CPB)手术后呼吸功能的影响。方法:选择24例心内直视手术患者,随机分成常规机械通气组(CMV)、早期肺开放组(EOL)、晚期肺开放组(LOL),EOL组在气管插管后实施肺开放策略,LOL组到达ICU后30min实施肺开放策略;分别于术前、CPB后及到ICU后120、240、360min记录各项呼吸指标:吸氧浓度、气道峰压、实际潮气量、呼气末气道正压(PEEP
2、)等并同时测动脉血气,计算氧合指数和动态肺顺应性。结果:CMV组CPB后及到ICU后120、240min肺动态顺应性较术前明显下降(P<;0.01),氧合指数CPB后各时段较术前明显下降(P<;0.01);E0L组肺动态顺应性CPB后未见下降;LOL组经实施肺开放后肺动态顺应性、氧合指数逐渐上升,但在到ICU120min前肺动态顺应性仍低于EOL组(P<;O.05);维持肺开放的最低PEEPLOL组高于EOL组(P<;0.01)o结论:OLC可减轻CPB相关的肺损伤,早期实施OLC
3、优于晚期实施OLC。【关键词】体外循环;肺开放策略;呼吸功能Effectsofopenlungconceptonrespiratoryfunctionaftercardiopulmonarybypass[Abstract]Objective:Toexploretheeffectsofopenlungconcept(OLC)onpulmonaryfunctioninpatientswhounderwentcardio-pu1monarybypass(CPB)・Methods:24patientsun
4、derwentcardiacsurgerywithCPBweredividedrandomlyintoconventionalmechanicalventilationgroup(CMV),OLCstarteddirectlyafterintubation(earlyopenlunggroup,EOL)andOLCstarted30minafterarrivalintheintensivecareunit(lateopenlunggroup,LOL)・Fi02,peakairwaypressure
5、,tidalvolume,andpositiveend-expiratorypressure(PEEP)weremeasured・Arterialbloodwastakenforgasanalysisatthesametimeandstaticpulmonarycompliance(Cst),oxygenindex(01)werecalculatedbeforeoperation,afterCPBand120min,240min,and360minafterarrivalinICU.ResuIts
6、:ComparedwiththesebeforeoperationandfromtheendofCPBto240minafterarrivalinICU,CdynwassignificantlylowerinCMVgroup(P&It;0.01)and01waslowertill360minafterarrivalinICU(P<;0.01).NoreducingofCdynwasfoundinEOLgroupafterCPB.InLOLgroup,Cdynand01begantoincrea
7、seafterOLCwasappliedbutCdynwaslowerthanthatofEOLgrouptill120minafterarrivalinICU(P<;0.05)andthePEEPneededtokeepthelungopenwashigher,whichwas12±0.71cmH20vs10±0cmH20(P&It;0・01).Conclusions:OLCventilationleadstoanattenuatedlunginjuryaftercardiacsurgery
8、.EarlyapplicationoftheOLChasamorepronouncedeffectcomparedwithlateapplicationofthisventilationstrategy.随着体外循环(CPB)技术的发展和心肌保护措施的应用,心脏直视手术得到了长足的进步,然而,CPB心脏手术后肺泡塌陷、呼吸功能下降仍是临床常见问题[1]。肺开放策略(OLC)作为一种保护性机械通气手段可使塌陷的肺泡开放、减轻肺损伤[2],因而在急性呼吸窘迫综合征(ARDS)被广泛应用