异丙酚对CPB心脏瓣膜置换术中肺损伤的保护作用

Influence of propofol on pulmonary function in patients undergoing cardiac valve replacement

目的观察异丙酚对体外循环(CPB)所致急性肺损伤的保护作用。方法选择首次择期CPB心脏瓣膜置换术患者30例,并随机分为观察组和对照组各15例,观察组在气管插管后靶控输注异丙酚至手术结束,对照组同法输注等量的生理盐水。于CPB前(诱导后静注异丙酚前,T1)、主动脉开放后10 m in(T2)、CPB结束时(T3)、手术结束时(T4)监测潮气量(VT)、气道峰压(Pm ax)、气道平台压(P lateau)及呼气末气道正压(PEEP),分别采动脉血1 m l测定动脉血氧分压(PaO2)及二氧化碳分压(PaCO2),同步检测吸入气氧浓度(F iO2)、大气压(PB),根据公式计算胸肺顺应性(C s)和动态肺顺应性(Cd)及呼吸指数(R I);分别于T1、T3、T4测定并记录平均肺动脉压(M PAP)、肺血管阻力指数(PVR I)。结果对照组C s、Cd在T2、T3、T4较T1及同时间点观察组明显下降(P<0.05),R I在T2,T3较T1及同时间点观察组明显升高(P<0.05);观察组M PAP、PVR I在T3、T4显著低于对照组(P<0.05)。结论异丙酚对CPB所致急性肺损伤有一定保护作用。

[Objective] To study the protective effect of propofol on acute lung injury in patients undergoing cardiopulmonary bypass （CPB）. [Methods] Thirty patients scheduled for cardiac value replacement for the first time were randomized into two groups： control group （group C, 15 patients） and propofol group （group P, 15 patients）. Group P was given target-controlled infusion （TCI） of propofol after tracheal intubation, while normal saline was given instead of propofol in group C. Pulmonary-thoracic compliance （Cs） and dynamic compliance （Cd） Were measured at pre-CPB （T1）, 10 minutes after aortic opening （T2）, at the end of CPB （T3） and operation （T4）.Arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2）, fractional concentration of oxygen in inspired gas （FiO2）, and barometric pressure （PB） were measured at the same time. Then respiratory indexes （RI） were calculated. Mean pulmonary arterial pressure （MPAP）, pulmonary vascular resistance index （PVRI） were measured and calculated at T1, T3, T4. [Results] There were no differences in the values of MPAP, PVRI,Cs, Cd and RI of T1 between two groups. Cs and Cd at T2, T3 and T4 decreased significantly during the control group compared with T1 and propofol group. The RI of the control group at T2, T3 were higher than that at T1 and propofol group at the same measure points （P〈0. 05）. There was no difference （P〈0. 05） between T4 and T1 in the control group, the values of the control group were higher than those of the propofol group at T4（P〈0. 05）. The difference of MPAP, PVRI at T3, T4 between the two groups was significant （P〈0. 05）. MPAP at T3 in group P was higher than that at T1. [Conclusion] Propofol has a protective effect on acute lung injury after CPB.