体外循环中肺动脉灌注和间断肺通气的肺保护作用

Protective effects of pulmonary artery perfusion and intermittent ventilation on lung during cardiopulmonary bypass

目的:探讨肺动脉灌注4℃含氧冷血和间断肺通气对体外循环(cardiopulmonary bypass,CPB)肺损伤的保护作用。方法:将30例符合条件的心脏手术患者采用随机数字表法分为两组:肺保护组(n=15):CPB期间经肺动脉间断灌注4℃含氧冷血,并在灌注期间给予间断肺通气;对照组(n=15):常规行心脏手术。记录呼吸机支持时间;分别在CPB前和CPB结束及结束后1、6 h测算氧合指数(OI)、呼吸指数(RI)、肺气道阻力(Raw)和肺静态顺应性(Cstat)。结果:术后肺保护组呼吸机支持时间明显短于对照组(P<0.05),肺保护组CPB结束后1、6 h OI、Cstat均显著高于对照组(P<0.05或P<0.01),而RI、Raw均显著低于对照组(P<0.05和P<0.01)。结论:肺动脉含氧冷血间断灌注及间断肺通气对CPB肺损伤有良好的保护作用。

Objective：To explore the protective effects of comprehensive measures,including pulmonary artery perfusion with 4℃ oxygenated blood and intermittent ventilation on lung during CPB.Methods：Thirty patients with rheumatic heart disease（RHD）or congenital heart defect（CHD）were divided into two groups with random number table：protective group（n =15）,given simultane-ously intermittent ventilation and pulmonary artery perfusion with 4℃ oxygenated blood on lung during CPB;control group（n =15）,performed using routine approaches.Mechanical ventilation time was recorded,the lung oxygenate index（OI）,respiratory index（RI）,airway resistance（Raw）and lung static compliance（Cstat）were detected at the beginning,ending,1 h and 6 h after CPB ter-mination,respectively.Results：The time of mechanical ventilation was significantly shorter in protective group than in the control group.The OI and Cstat of protective group at 1 h and 6 h after CPB termination was significantly better than that of the control group（P 〈 0.05,P 〈 0.01,respectively）;the Raw and RI of protective group was significantly lower than that of control group at 1 h and 6 h（P 〈 0.05,P 〈 0.01,respectively）.Conclusion：Comprehensive measures,pulmonary artery perfusion with 4℃ oxygenat-ed blood and intermittent ventilation,has protective effects on lung injury during CPB.