术中iv维生素C对心脏手术患者术后肺部并发症的影响

Effect of intravenous injection of Vitamin C on postoperative pulmonary complications in patients undergoing cardiac surgery

目的观察术中iv维生素C对心肺转流下行心脏手术患者术后肺部并发症的影响。方法选取2018年12月—2019年8月在徐州医科大学附属医院择期在心肺转流下行心脏手术最终的70例患者为研究对象,采用随机序列法将患者分为对照组(37例)和维生素C组(33例)。维生素C组患者分别在麻醉诱导后10 min、体外循环后并行开始前10 min、胸骨完全闭合后予iv维生素C注射液,1 g用生理盐水稀释至10 mL,总量3 g。对照组患者在同等时间静脉注射10 mL生理盐水。记录患者术后肺部并发症发生率、严重度评分及种类。分别于插管后10 min(T0)、胸骨完全闭合后(T1)、术后第1天(T2)、术后第3天(T3)记录患者氧合指数(PaO2/FiO2)、肺泡动脉血氧分压差(A-aDO2)。并于T0、T1记录肺动态顺应性(Cd)、肺静态顺应性(Cs)。观察患者术后其他并发症发生情况。结果与T0时刻比较,两组T1~T3时刻PaO2/FiO2、A-aDO2明显降低(P<0.01);两组T1时刻Cd、Cs明显升高(P<0.05)。维生素C组术后肺部并发症发生率为12.12%,显著低于对照组的29.73%(P<0.05)。与对照组相比,维生素C组患者术后肺部评分显著降低(P<0.01)。术后患者其他并发症以房颤最常见,但两组间差异无统计学意义。结论术中iv维生素C能够降低心脏手术患者术后肺部并发症评分,减少术后肺部并发症发生率,改善患者的肺功能。

Objective To observe the effect of intravenous injection of Vitamin C on postoperative pulmonary complications in patients undergoing cardiac surgery.Methods A total of 70 patients who underwent cardiopulmonary bypass in the Affiliated Hospital of Xuzhou Medical University from December 2018 to August 2019 were selected as study subjects,and the patients were divided into control group(37 cases)and vitamin C group(33 cases)by random sequence method.Patients in the vitamin C group were iv administered with Vitamin C injection at 10 min after anesthesia induction,10 min before cardiopulmonary bypass,and complete closure of sternum,respectively,1 g was diluted with normal saline 10 mL,and the total amount was 3 g.Patients in the control group received 10 mL of normal saline intravenously at the same time.The incidence,severity score and types of postoperative pulmonary complications were recorded.Patients’PaO2/FiO2 and A-aDO2 were recorded at 10 min after intubation(T0),after complete sternal closure(T1),first day after surgery(T2),and third day after surgery(T3).And the Cd and Cs were recorded at T0 and T1.Other postoperative complications were observed.Results Compared with time of T0,PaO2/FiO2 and A-aDO2 in two groups were significantly reduced at time of T1—T3(P<0.01),and the Cd and Cs were significantly increased in two groups at time of T1(P<0.05).The incidence of postoperative pulmonary complications in the vitamin C group was 12.12%,which was significantly lower than 29.73%in the control group(P<0.05).Compared with the control group,postoperative pulmonary scores in the vitamin C group were significantly decreased(P<0.01).Atrial fibrillation was the most common postoperative complication,but there was no significant difference between two groups.Conclusion Intraoperative intravenous vitamin C can reduce postoperative pulmonary complications score,reduce the incidence of postoperative pulmonary complications,and improve the pulmonary function of patients undergoing cardiac surgery.