静脉吸入复合全麻下体外循环对肺泡-动脉血氧分压差(PA-aO_2)的影响

Effects of extracorporeal circulation(CPB) on alveolar-blood oxygen partial pressure difference(PA-aO_2) under Intravenous and inhaled anesthesia

目的观察体外循环(extracorporeal circulation,CPB)对肺泡-动脉血氧分压差(PA-aO2)的影响。方法择期行心脏外科手术的患者68例。CPB时间均在300min以内,阻断时间均在180min以下。其中,男性33例,女性35例;年龄在0～18岁的32例,19～60岁36例;行缺损修补手术的42例,瓣膜置换手术的26例。使用异丙酚和七氟醚静吸复合全麻,于CPB前10min和CPB后10min取患者动脉血行血气分析,测定CPB前后的肺泡-动脉血氧分压差(PA-aO2)。按照患者性别、年龄、手术类型分组比较CPB前后的肺泡-动脉血氧分压差(PA-aO2)有无明显改变以及CPB前后的肺泡-动脉血氧分压差(PA-aO2)的差值与CPB时间和阻断时间是否相关。结果68例动脉血行血气分析结果:CPB前和CPB后肺泡-动脉血氧分压差(PA-aO2)的差值无统计学意义(P>0.05);CPB前和CPB后肺泡-动脉血氧分压差(PA-aO2)的差值与患者性别,年龄,手术类型无相关性,但是随CPB时间和阻断时间的延长而差值增大。结论静吸复合全麻下,CPB时间在300min以内,阻断时间在180min以下,对患者肺泡-动脉血氧分压差(PA-aO2)没有明显影响,对肺换气功能也没有明显影响。但随着CPB尤其是阻断时间的延长,CPB前后的肺泡-动脉血氧分压差(PA-aO2)的差值可能会增大,从而引起肺换气功能的变化。

Objective To observe the effects of extracorporeal circulation（CPB） on alveolar-blood oxygen partial pressure difference（PA-aO2）. Methods Choose 68 patients undergoing elective cardiac operation,including 33 male patients and 35 female patients,32 patients of Age at 0 ～ 18 years old and 36 patients of Age at 19～60 years old,and 42 patients undergoing defect repair surgery and 26 patients undergoing valve replacement operation.Use intravenous and inhaled anesthesia with propofol and sevoflurane,and then get patients artery blood for blood gas analysis at 10 minutes before CPB and 10 minutes after CPB 10 minutes.Make groups according to gender,age,and surgery type to compare PA-aO2 before and after CPB. Results There were no statistical significantly difference in the of alveolar-blood oxygen partial pressure difference（PA-aO2） before and after CPB.There were no relationships in the difference of PA-aO2 before and after CPB with gender,age,or surgery type,but the difference of PA-aO2 before and after CPB had changed with the time of CPB and cycle block. Conclusion CPB has no significant effect on alveolar-blood oxygen partial pressure difference（PA-aO2）,but as the time of CPB and cycle block going,the difference of PA-aO2 before and after CPB will be more obvious,and the pulmonary respiratory function will change.