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

中文关键词: 瓣膜置换手术  心肺转流  肺损伤  静态膨肺  七氟醚

英文关键词: Cardiac valve replacement  Cardiopulmonary bypass  Lung injury  Static inflation  Sevoflurane

中文摘要:

      
目的 评价不同浓度七氟醚对静态膨肺患者心肺转流(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,ASA Ⅱ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10 cmH2O,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、6 h抽取动脉血行血气分析。计算肺泡-动脉氧分压差（DA-aO2）、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、6 h三组DA-aO2、RI明显升高（P<0.05）；CPB停机后1 h三组OI明显降低(P<0.05)。三组不同时点DA-aO2、RI和OI差异无统计学意义。三组CPB停机后1、3、6 h发生OI<300 mmHg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10 cmH2O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。

英文摘要:

      
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 status Ⅱ or Ⅲ level, were randomly divided into three groups (n=25), pulmonary static inflation with 10 cmH2O, 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 （DA-aO2),respiratory index （RI, DA-aO2/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, DA-aO2 and RI were significantly higher at 1，3，6 h after CPB weaning in all three groups (P<0.05). Compared with before surgery, OI was significantly lower at 1 h after CPB weaning in all three groups (P<0.05). There was no statistically significant difference among the three groups in DA-aO2, RI and OI at different time points. There were no significant difference among the groups in the occurrence of OI less than 300 mmHg, tracheal intubation time and ICU stay time at 1, 3, 6 h after CPB weaning.
Conclusion In patients undergoing cardiac valve replacement surgery, pulmonary static infation with 10 cmH2O during CPB, inhaled 1％ sevoflurane or 2％ sevoflurane do not improve postoperative pulmonary gas exchange function.