摘要
目的探讨心脏瓣膜术中早期应用个体化呼气末正压(PEEP)对患者肺功能的影响。方法选择2019年7—10月择期行瓣膜手术的患者33例,男11例,女22例,年龄40~70岁,BMI 18~26 kg/m^(2),ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组:对照组(C组,n=17)和个体化PEEP组(P组,n=16),两组术中麻醉维持为全凭静脉麻醉。停机后P组采用阶梯PEEP法滴定适宜的PEEP,并维持至手术结束,C组设置固定PEEP 4 cmH 2O。记录手术前(T_(0))、肺复张前(T_(1))、肺复张后40 min(T_(2))、术后2 h(T_(3))、术后24 h(T_(4))的氧合指数(PaO_(2)/FiO_(2)),T_(0)—T_(2)时的HR、MAP、CVP,T_(1)—T_(3)时的肺动态顺应性(Cdyn)。使用经胸超声检查并记录T 0、T_(2)—T_(4)时的肺超声评分(LUS评分)和术后肺部并发症的发生情况。结果与T_(1)时比较,T_(2)、T_(3)时P组PaO_(2)/FiO_(2)和Cdyn明显升高(P<0.05)。与C组比较,T_(2)时P组PaO_(2)/FiO_(2)和Cdyn均明显升高(P<0.05),T_(2)—T_(4)时P组LUS评分明显降低(P<0.05),P组术后肺水肿的发生率明显降低(P<0.05)。两组其余术后肺部并发症发生率差异无统计学意义。结论在心脏瓣膜手术心肺转流停机后早期应用个体化PEEP具有肺保护作用。
Objective To explore the lung protective effect of early application of individualized postive end-expiratory pressure(PEEP)in heart valve surgery.Methods A total of 33 patients undergoing valvular surgery during July to October 2019,11 males and 22 females,aged 40-70 years,BMI 18-26 kg/m^(2),ASA physical statusⅡorⅢ,NYHA cardiac function gradeⅡorⅢ,were divided into two groups by random number table method:control group(group C,n=17)and the individualized PEEP group(group P,n=16),and the intraoperative anesthesia was maintained by intravenous anesthesia in the two groups.After the cardiopulmonary bypass,the appropriate PEEP was titrated by the step PEEP method in group P and maintained until the end of the operation,and the fixed PEEP 4 cmH_(2)O was set in group C.The oxygenation index(PaO_(2)/FiO_(2))before surgery(T_(0)),before lung recruitment(T_(1)),40 minutes after lung recruitment(T_(2)),2 hours after surgery(T_(3)),24 hours after surgery(T_(4))were recorded.The HR,MAP,CVP at T 0-T_(2) and dynamic lung compliance(Cdyn)at T_(1)-T_(3) were recorded.LUS score by transthoracic ultrasound at T 0,T_(2)-T_(4) and postoperative pulmanary complications(PPCs)were also recorded.Results Compared with T_(1),the PaO_(2)/FiO_(2) and Cdyn of group P at T_(2)and T_(3)were lower(P<0.05).The PaO_(2)/FiO_(2) and Cdyn of group P at T_(2) were significantly higher than those of group C(P<0.05).The LUS scores of group P at T_(2)-T_(4) were lower than those of group C(P<0.05).The incidence of postoperative pulmonary edema in group P was significantly lower than that in group C(P<0.05).There was no statistical significance in the incidence of other PPCs between the two groups.Conclusion Early application of personalized PEEP after cardiopulmonary bypass during cardiac valve surgery has a protective effect on lung function.
作者
王悠然
葛亚力
魏海燕
施韬
苏中宏
王晓亮
史宏伟
WANG Youran;GE Yali;WEI Haiyan;SHI Tao;SU Zhonghong;WANG Xiaoliang;SHI Hongwei(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2021年第8期822-827,共6页
Journal of Clinical Anesthesiology
关键词
个体化呼气末正压
心脏手术
肺超声
术后肺部并发症
Individualized postive end-expiratory pressure
Cardiac surgery
Lung ultrasound
Postoperative lung complication
作者简介
通信作者:葛亚力,Email:ge_yl@163.com。
