跨肺压监测在急性主动脉夹层Stanford A型手术后患者中的应用研究

Application of trans-pulmonary pressure monitoring for post operative patients with acute type A Stanford aortic dissection

目的探讨跨肺压监测在急性主动脉夹层Stanford A型手术后患者中的应用。方法选择2015年1-10月收治我院重症医学科经CT确诊"急性主动脉夹层Stanford A型"在急诊全麻深低温体外循环下行"Cabrol加升主动脉及全弓替换加降主动脉支架象鼻手术患者19例,随机分为两组,观察组9例,对照组10例。两组患者入室后,每日均给予肺复张治疗,观察组患者通过食道压监测设定呼气末正压(PEEP)值,维持跨肺压为正值;对照组患者则通过PEEP递增法设定PEEP值,观察两组患者0 h、24 h、48 h、72 h肺顺应性、氧合指数、PEEP值及总机械通气时间、住ICU时间、住院时间。结果两组患者0 h及入室时肺顺应性、氧合指数、PEEP值比较差异无统计学意义(P>0.05),入室后观察组患者通过食道压监测维持呼气末跨肺压为正值后24 h、48 h、72 h监测肺顺应性、氧合指数、PEEP值高于对照组,两组比较差异有统计学意义(P<0.05),观察组总机械通气时间少于对照组(P<0.05),两组患者住ICU时间、住院时间比较差异无统计学意义(P>0.05)。结论通过食道压监测设定PEEP值在急性主动脉夹层Stanford A型手术后患者跨肺压维持方面具有指导意义,且在维持跨肺压的过程中更需要护士精心护理,规范护理操作,连续监测、自动调整气囊压力,保持呼吸机管路的密闭性。

Objective To study the application effect of trans-pulmonary pressure monitoring for post operative patients with acute type A Stanford aortic dissection. Methods 19 patients were selected from 1st of January,2015 to 31 st of October,2015.They were diagnosed by CT with acute Type A Stanford aortic dissection undergoing complex surgeries of Cabrol and ascending aorta and aortic arch replacement combined with descending aortic stent elephant trunk surgery via deep hypothermic cardiopulmonary bypass. They were randomly divided into two groups,9 cases in observation group,10 cases in control group. The value of positive end expiratory pressure（ PEEP） was maintained positively via esophageal pressure monitoring in observation group. The value of PEEP in control group has been set to increase gradually. The lung compliance at 0 hour,24 hours,48 hours and 72 hours,oxygenation index,PEEP value and the total mechanical ventilation time,ICU stay time and hospitalization time for two groups were measured and compared. Results The baseline lung compliance,oxygenation index,PEEP values were not statistically significant（ P 〉0. 05）. There was statistically significant difference of the value of PEEP at 24 hours,48 hours and 72 hours（ P〈0.05）. The PEEP values in observation group were significantly higher than that of control group. The two groups of patients with mechanical ventilation time are consistent. The observation group was less than that in control group（ P 〈 0. 05）. The stay time in intensive care unit and hospitalization time had no statistical significance（ P 〉 0. 05）. Conclusion It is significant to monitor the value of Stanford A for patients with acute aortic dissection by monitoring the value of PEEP in the maintenance of pulmonary pressure after acute aortic dissection. In the process of maintaining the lung pressure,the nurses need to be monitored closely,standard nursing operation,continuous monitoring,automatic adjustment of the pressure of the air bag,and maintain the sealing performance of the ventilator pipeline.