零平衡超滤对冠状动脉旁路移植术后患者肺功能的影响

Effect of Zero-balanced Ultrafiltration on Postoperative Lung Function in Coronary Artery Bypass Grafting Patients

目的探讨零平衡超滤对改善体外循环(CPB)冠状动脉旁路移植术(CABG)患者术后肺功能的临床效果。方法选择2006年6月至2008年12月在中国医科大学附属第一医院接受CABG患者40例,按照采用的不同超滤方法分为两组,试验组(n=20):男14例,女6例;年龄65.43±8.31岁;于CPB开始后行零平衡超滤及常规超滤;对照组(n=20):男15例,女5例;年龄66.51±7.62岁;仅于复温后施行常规超滤。术前常规检测两组患者肺功能和动脉血气分析;分别于CPB前、CPB结束时、术后6 h和12h测定两组患者气道阻力(Raw)、氧合指数(OI)和肺泡-动脉血氧分压差[P(A-a)O2],记录术后呼吸机辅助通气时间。结果两组患者术前肺功能和动脉血气指标比较差异均无统计学意义(P>0.05)。两组患者CPB前Raw、OI和P(A-a)O2比较差异无统计学意义(P>0.05),而术后6 h和12 h试验组的Raw显著低于对照组[2.22±0.31 cm H2O/(L.s)vs.2.94±0.42 cm H2O/(L.s),F=0.061,P<0.05;1.89±0.51 cm H2O/(L.s)vs.2.52±0.29 cm H2O/(L.s),F=0.096,P<0.05];术后6 h和12 h试验组P(A-a)O2显著低于对照组(86.74±7.63 mm Hg vs.111.66±7.49 mm Hg,F=0.036,P<0.05;74.82±5.67 mm Hg vs.95.23±6.78 mm Hg,F=0.059,P<0.05);术后6 h和12 h试验组OI显著高于对照组(384.33±30.67 vs.324.63±31.22,F=0.033,P<0.05;342.24±23.43 vs.293.67±25.44,F=0.047,P<0.05);术后呼吸机辅助通气时间试验组短于对照组(15.44±3.93 h vs.20.68±5.77 h,P<0.05)。结论零平衡超滤可以改善CABG患者术后肺功能、缩短术后机械通气时间。

Objective To investigate the clinical effect of using zero-balanced ultrafiltration on postoperative lung function of coronary artery bypass grafting（CABG） patients under cardiopulmonary bypass（CPB）. Methods Forty coronary artery bypass grafting patients in the First Affiliated Hospital of China Medical University from June 2006 to December 2008 were enrolled in this study,and were divided into two groups based on different ultrafiltration procedures.Patients in the experimental group（n=20）,14 males and 6 females,with an age of 65.43±8.31 years,underwent zero-balanced ultrafiltration and conventional ultrafiltration after CPB was carried out.Patients in the control group（n=20）,15 males and 5 females,with an age of 66.51±7.62 years,only underwent conventional ultrafiltration after temperature restoration.Preoperative pulmonary function and arterial blood gas were tested routinely.Airway resistance（Raw）,oxygenation index（OI） and alveolar-arterial oxygen difference [P（A-a）O2] were measured at the following points： before CPB,at the end of CPB,6 hours,and 12 hours after operation.Postoperative mechanical ventilation time was also recorded. Results There was no significantly statistical difference between the two groups of patients in pulmonary function and arterial blood gas indexes before operation,and Raw,OI and P（A-a）O2 before CPB（P〉0.05）. Nevertheless,at the points of 6 hours and 12 hours after operation,Raw [2.22±0.31 cm H2O/（L·s） vs.2.94±0.42 cm H2O/（L·s）,F=0.061,P〈0.05; 1.89±0.51 cm H2O/（L·s） vs.2.52±0.29 cm H2O/（L·s）,F=0.096,P〈0.05] and P（A-a）O2（86.74±7.63 mm Hg vs.111.66±7.49 mm Hg,F=0.036,P〈0.05;74.82±5.67 mm Hg vs.95.23±6.78 mm Hg,F=0.059,P〈0.05） of patients in the experimental group were significantly lower than those of patients in the control group.At the same points,OI of patients in the experimental group was significantly higher than that of patients in the control group（384.33±30.67 vs.324.63±31.22,F=0.033,P〈0.05;342.24±23.43 vs.293.67±25.44,F=0.047,P〈0.05）.Ventilator support time of the experimental group was shorter than the control group（15.44±3.93 h vs.20.68±5.77 h,P〈0.05）. Conclusion Zero-balanced ultrafiltration can improve pulmonary function after coronary artery bypass grafting and shorten postoperative mechanical ventilation time.