胸膜腔完整性对非体外循环冠状动脉旁路移植术后呼吸系统的影响

Influence of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting

目的 通过研究非体外循环冠状动脉旁路移植术（OPCABG）后呼吸系统并发症,探讨保持胸膜腔完整性对OPCABG术后呼吸系统的影响.方法 OPCABG患者102例,其中术中胸膜腔开放49例（胸膜腔开放组）,术中胸膜腔密闭53例（胸膜腔密闭组）.比较两组术后呼吸机辅助时间和监护室入住时间、胸腔积液量、呼吸衰竭以及肺不张的发生率.结果 胸膜腔开放组术后呼吸机辅助时间、监护室入住时间较胸膜腔密闭组延长[（40.3±4.8）h比（28.6±6.8）h,（78.3±10.8）h比（54.8±6.1） h],差异有统计学意义（P＜ 0.01或＜0.05）.胸膜腔开放组术后胸腔积液量高于胸膜腔密闭组[（800.0±60.5） ml比（350.0±28.6） ml],差异有统计学意义（P＜0.01）.胸膜腔开放组术后肺不张、呼吸衰竭发生率高于胸膜腔密闭组[36.7％（18/49）比15.1％（8/53）,38.8％（19/49）比18.9％（10/53）],差异有统计学意义（P＜0.01）.结论 OPCABG作为纵隔内手术,避免胸膜腔开放可以减少术后呼吸系统并发症的发生.

Objective To explore the effect of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting （OPCABG）,through comparing the respiratory complication after OPCABG.Methods One hundred and two patients were accepted OPCABG,among whom 49 patients＆#39; pleural cavities were opened （open group） and 53 patients＆#39; pleural cavities were closed （close group）.The ventilation time,intensive care unit time,pleural effusion,the rate of atelectasis and respiratory failure after operation were compared between two groups.Results The ventilation time and intensive care unit time in open group were （40.3 ± 4.8） h and （78.3 ± 10.8） h,in open group were （28.6 ± 6.8） h and （54.8 ± 6.1） h.The ventilation time and intensive care time in open group were significantly longer than those in close group（P 〈 0.01 or 〈 0.05）.The pleural effusion in open group was （800.0 ± 60.5） ml,in close group was （350.0 ± 28.6） ml.The pleural effusion in open group was significantly higher than that in close group （P 〈 0.01）.The rate of postoperative atelectasis and respiratory failure in open group were 36.7%（18/49） and 38.8%（19/49）,in close group were 15.1%（8/53） and 18.9%（10/53）.The rate of postoperative atelectasis and respiratory failure in open group were significantly higher than those in close group （P 〈 0.01）.Conclusions OPCABG is the operation in mediastinum.To avoid pleural cavity opened in OPCABG can reduce the incidence of postoperative respiratory complication.