肺复张手法在成人心脏体外循环术后的临床应用分析

Clinical Application of Lung Recruitment Maneuvers in Adults after Cardiopulmonary Bypass

目的探讨肺复张手法在成人心脏体外循环术后应用的可行性.方法对心脏术后42例不同程度呼吸功能不全进行机械通气病人行间歇肺复张手法治疗,采用双相气道正压通气(BIPAP),镇静情况下,每60s增加吸气压(25～40cmH2O)与呼气末压(PEEP)(10～25cmH2O)各5cmH2O,之后还原到原基础通气,监测整个过程中的呼吸、血液动力学变化.结果肺复张后全部病例的氧合指数、肺静态顺应性等呼吸指标明显提高,有统计学意义(P<0.05),无明显血液动力学改变(P>0.05).结论肺复张手法能改善患者呼吸功能,预防心血管不良事件,在心脏体外循环术后应用是可行的。

Objective To investigate the feasibility of recruitment maneuvers in adult patients after cardiopulmonary bypass.Methods Forty-two patients with respiratory insufficiency after cardiopulmonary bypass operation were treated with mechanical ventilation combined with lung recruitment maneuvers.The patients was calmed and treated with bi-phasic positive airway pressure（BIPAP）.The inspiratory pressure was enhanced 5 cmH2O in the base of 25～40 cmH2O,positive end-expiratory pressure（PEEP） was enhanced 5 cmH2O in the base of 10 ～25 cmH2O,then returned to the original condition.The changes of breath and hemodynamics were monitored during the whole process.Result The oxygenation index and static lung compliance were improved obviously（P〈0.05）,while the hemodynamics changed little（P〈0.05）.Conclusions Lung recruitment maneuvers can improve patients＇ breath function.Good preparation and strict manipulation can prevent the adverse cardiovascular events.Recruitment maneuvers is feasible in adult patients after cardiopulmonary bypass Operations.