不同通气策略对体外循环心脏术后急性肺损伤效果的对比观察

The comparative study of different ventilation tactics to prevent postoperative acute lung injury during cardiopulmonary bypass in cardiac surgery

目的探讨不同通气策略对体外循环心脏术后急性肺损伤的影响。方法将施行体外循环下心脏手术后并发低氧血症患者84例随机分成2组,对照组(n=46)采用单纯肺保护性通气方式进行机械通气治疗,观察组(n=38)采用肺复张结合肺保护性通气方式进行机械通气治疗,比较2组的临床疗效。结果观察组机械通气时间和住ICU时间均明显短于对照组(P<0.01),而肺顺应性明显好于对照组(P<0.05);与复张/通气前比较,2组复张/通气时患者HR、MAP和CVP均有所变化,但幅度较小差异无统计学意义(P>0.05),不影响治疗;与复张/通气前比较,2组患者复张/通气后24 h、48 h时PaO_2和PaO_2/FiO_2均显著提高(P<0.05),且观察组显著高于对照组(P<0.05);2组病死率比较差异无统计学意义(26.09%vs 10.53%,P>0.05)。结论肺复张术可有效改善体外循环心脏手术后患者的低氧血症,缩短住院时间,促进患者康复。

Objective To explore the effect of different ventilation tactics to prevent postoperative lung injury during cardiopulmonary bypass in cardiac surgery. Methods Eighty-four cases with cardiopulmonary bypass in cardiac surgery and hypoxemia were divided into control group （ n = 46） and observation group （ n = 38 ）. The patients of control group received lung protective ventilation strategy. The patients of observation group received lung protective ventilation strategy and recruitment maneuvers. The clinical efficacy of two groups were compared. Results Observation group of mechanical ventilation and ICU stay were significantly shorter than the control group （ P 〈0.01 ）, and lung compliance was significantly better than the control group （ P 〈 0.05 ） ; and reexpansion/ventilation before comparing two groups reexpansion/ventilation in patients with HR, MAP and CVP has been changed to a lesser extent the difference was not statistically significant （ P 〉 0.05 ） , does not affect the treatment; and reexpansion / ventilation before comparing two groups of patients reexpansion / ventilation after 24 h, 48 h when PaO2 and PaO2/Fi02 were significantly increased （ P 〈 0.05 ） , and the observation group was significantly higher （ P 〈0.05） ; 2 group died rate difference was not statistically significant （26.09% vs. 10.53%, P 〉0.05）. Conclusion Recruitment maneuvers surgery can improve postoperative hypoxemia during cardiopulmonary bypass in cardiac surgery, rescue in hospital time and promote patients recovery.