成人心内直视手术中肺阻力变化的监测

Determination of Lung Resistance in Cardiac Surgical Patient

目的:探讨强迫振荡肺阻力测定技术研究心内直视手术患者围麻醉期肺阻力变化规律和异常表现的临床意义。方法:心内直视手术成年患者30例,行芬太尼静脉全麻,用CUSTOVITM肺功能仪以4Hz振荡频率测定术前常规(坐位)、仰卧位、机械通气(IPPV)、开胸后、体外循环心肺转流(CPB)前、CPB中、CPB后关心包前、关胸前、关胸后及术终等10个时间点的相位角(Phi)参数值。结果:术中4HzPhi在20°～30°范围,该相位角参数受不同手术和转流时间的影响:风心病组CPB后至术终各时间点均低于先心病组(P<0.05)。与IPPV比较,术终4HzPhi均与之呈正相关(P<0.05);与CPB前比较,CPB后4HzPhi先心病组呈正相关(P<0.05),而风心病组相关性不明显(P>0.05)。结论:围麻醉期Phi的连续监测可以了解患者肺阻力变化,指导对某些呼吸功能不全的治疗,从呼吸力学的角度评价手术预后。

Objective： To evaluate the changes in lung resistance and its clinical significance in open heart surgical patients using forced oscillation technique. Methods： With CUSTO VITM lung function apparatus,values for the phase angle （Phi） of 4 Hz were determined for 30 adult patients anesthetized intravenously by Fentanyl at 10 time-paints： before surgery （sitting position）, supine position, intermittent positive ventilation （IPPV）, after chest opening, before, during and after cardiopulmonary bypass （CPB）, before pericardium closing before and after chest closing, and the end of operation. Results： Throughout the operation, the Phi values were in the range of 20^-30~and influenced by the types of the operations and the lasting time of CPB. Conclusion： Continuously monitoring Phi during peri-anesthesia period may be used to understand the influence of the disease and operation process on patient＇s lung resistance and guide the treatment of certain respiratory insufficiency, as well as evaluate the operation prognosis in terms of respiratory mechanics.