周期性膨肺在ICU体外循环心脏外科术后患者中的应用

Periodic pulmonary expansion for patients after cardiopulmonary bypass surgery in ICU

目的 研究周期性膨肺在体外循环心脏外科手术后患者中的应用.方法 连续收集本院ICU 2013年12月至2016年3月体外循环下行心脏外科手术的患者,随机分为对照组和实验组.对照组采用常规治疗方法,不进行膨肺;实验组采用周期性膨肺进行治疗,间隔周期为2h,分别采集第1次膨肺后（T0）、第2次膨肺后（T1）、第3次膨肺后（T2）、第4次膨肺后（T3）后30 min以及气管插管拔管之前（T4）患者动脉血PO2,计算氧合指数（PO2/FiO2）,气管插管时间,住ICU时间.结果 共有97例患者入选,2例因二次手术剔除,分为实验组47例、对照组48例.实验组在每次膨肺后4个时间点上以及在拔管之前的氧合指数均高于对照组,差异均有统计学意义（均P＜ 0.05）.实验组在气管插管时间和ICU停留时间上较对照组有所缩短,但差异无统计学意义（P＞0.05）.结论 周期性膨肺可以改善体外循环心脏手术患者的氧合指数,预防肺不张的发生.

Objective To study the effect of periodic pulmonary expansion for patients after cardiopulmonary bypass surgery.Methods The patients who underwent cardiac surgery in vitro circulation at the ICU of our hospital from December,2013 to March,2016 were collected and randomly divided into an experimental group and a control group.The control group were routinely treated.The experimental group were treated with periodic pulmonary expansion every 2 hours.After the first （T0）,second （T1）,and third （T2）expansions,30 min after the fourth expansion,and before trachea extubation （T4）,the patients＇ arterial blood PO2 were collected,and the oxygenation index （PO2/FiO2） was calculated.The tracheal intubation time and ICU stay were recorded.Results 97 patients were included,and 2 were excluded because of second operation,and there were 47 in the experimental group and 48 in the control group.At T0,T1,T2,T3,and T4,the PO2/FiO2 were higher in the experimental grou than in the control group,with statistical differences （all P 〈 0.05）.The tracheal intubation time and ICU stay were shorter in the experimental group than in the control group,but with no statistical differences （both P 〉 0.05）.Conclusion Periodic pulmonary expansion for patients after cardiopulmonary bypass surgery can improve their oxygenation and prevent the occurrence of atelectasis.