心脏瓣膜置换术中不同阶段应用等剂量七氟醚对肺功能的影响

Influence of using same dose sevoflurane in different phase during valve replacement surgery on lung function

目的观察心脏瓣膜置换术中不同阶段应用等剂量七氟醚对体外循环(CPB)下术后肺功能的保护作用。方法将心脏瓣膜置换术成年患者60例随机分成对照组(C组:手术期间未吸入七氟醚)、七氟醚全程处理组(S1组:手术中全程吸入1MAC七氟醚,CPB期间经膜肺吹入1MAC七氟醚)、七氟醚预处理组(S2组:麻醉插管后即刻应用1MAC七氟醚到CPB开始前停用)和七氟醚后处理组(S3组:升主动脉开放后即刻应用1MAC七氟醚直到手术结束)。分别于手术开始前(T0)、手术结束时(T1)、术后2h(T2)、术后6h(T3)、拔出气管导管前30min(T4)行血气分析,计算M指数(PaO2/PAO2)、呼吸指数(RI)及氧合指数(OI),并观察患者术后呼吸机支持时间、患者带气管导管时间、呼吸系统并发症及ICU滞留时间。结果术后与C组比较,S1、S2、S3组患者在T1、T2和T3时刻的肺功能指标水平较优(P<0.05),同时S1更优于S2、S3(P<0.05);与C组比较,S1、S2、S3组患者术后呼吸机支持时间、患者带气管导管时间及ICU滞留时间均缩短(P<0.05),同时S1组更短于S2、S3组(P<0.05);S1、S2、S3组患者术后呼吸系统并发症发生率低于C组。结论心脏瓣膜置换手术中应用1MAC七氟醚对肺功能具有保护作用;全程应用七氟醚优于预处理和后处理。

Objective To observe if same dose sevoflurane in different phase could protect lung function after CPB during valve replacement surgery.Methods 60 patients received valve replacement surgery were divided into control group （C group：no sevoflurane）,whole course sevoflurane treatedgroup （S1 group：1 MAC sevoflurane during the whole surgery course,1 MAC sevoflurane during CPB through membrane lung during CPB）,sevo-preconditioning group （S2 group：1 MAC sevoflurane treatment since immediately after intubation till the start of CPB）;and sevopostconditioning group （S3 group：1 MAC sevoflurane since immediately after aorta ascendens clamps open until the end of surgery）.Blood gas analysis were performed before surgery （T0 ）,at the end of surgery （T1 ）,2,6 h after surgery and 30 min before extubation （T2 -T4 ）,MI （PaO2/PAO2 ）,RI and OI were also calculated at these time points.Observed the time pa-tients need ventilator support,patients with tubation,Respiratory complications and ICU stay time.Results Compared to C group after surgery,patients from S1 ,S2 ,S3 groups lung function were better at T1 ,T2 and T3 （P 〈0.05）,while S1 were better than S2 ,S3 （P 〈0.05）;time of ventilator assisting,with endotracheal tube and ICU stay were shorter in group S1 ,S2 ,S3 than those in the C group （P 〈0.05）, while S1 is shorter than S2 and S3 （P〈0.05）.Respiratory complications were less in Sevo groups than in control group.Conclusion 1 MAC sevoflurane in valve replacement surgery can protect lung function;whole course sevoflurane treatment was better than preconditioning and postconditioning with sevoflurane.