零平衡超滤在急性A型主动脉夹层手术中的肺保护作用

The lung protective effect by zero-balance ultrafiltration in acute type A aortic dissection surgery

目的探讨零平衡超滤对急性A型主动脉夹层手术患者的肺保护作用。方法连续选取2019年1—12月于首都医科大学附属北京安贞医院接受手术治疗的急性A型主动脉夹层患者60例进行前瞻性随机对照研究,采用随机数字表法将患者分为观察组和对照组,各30例。观察组患者术中予零平衡超滤,对照组患者术中予常规超滤,比较2组手术及围术期资料、肺保护作用及预后情况。结果观察组与对照组体外循环时间、主动脉阻断时间、停循环时间、普通超滤量及手术方式比较差异均无统计学意义(均P>0.05)。2组术前乳酸、动脉血氧分压、动脉血氧饱和度、氧合指数差异均无统计学意义(均P>0.05);观察组术中并行阶段(T_(1))、术后1 h(T_(3))动脉血氧分压、动脉血氧饱和度、氧合指数均高于对照组[T_(1)时点:(174±82)mmHg(1 mmHg=0.133 k Pa)比(130±73)mmHg、(98.5±2.4)%比(94.6±6.7)%、(289±137)mmHg比(216±122)mmHg;T_(3)时点:(156±70)mmHg比(86±17)mmHg、(98.2±1.3)%比(96.0±2.9)%、(249±119)mmHg比(143±32)mmHg],差异均有统计学意义(均P<0.05)。观察组术后出现急性肺损伤、急性呼吸窘迫比例均低于对照组,住院天数少于对照组,差异有统计学意义(均P<0.05)。结论急性A型主动脉夹层患者术中联合使用零平衡超滤在围术期肺保护方面效果显著。

Objective To investigate the lung protective effect by zero-balance ultrafiltration in patients undergoing acute type A aortic dissection surgery.Methods From January to December 2019,60 patients with acute type A aortic dissection who underwent surgical repair in Beijing Anzhen Hospital,Capital Medical University were enrolled to conduct a prospective randomized controlled study.Patients were randomly divided into two groups,with 30 cases in each group.The zero-balance ultrafiltration was used for the patients in observation group,and the normal ultrafiltration was used for the patients in control group.The operative and perioperative datas,lung protective effect and prognosis were compared between the two groups.Results There were no significant differences in cardiopulmonary bypass time,aortic occlusion time,circulatory arrest time,normal ultrafiltration volume and surgical approach between the two groups(all P>0.05).Before operation,there were no significant differences in lactic acid,arterial oxygen partial pressure,arterial oxygen saturation and oxygenation index between the two groups(all P>0.05);during parallel phase(T_(1))and 1 h after operation(T_(3)),arterial oxygen partial pressure,arterial oxygen saturation and oxygenation index in observation group were higher than those in control group[T_(1)time point:(174±82)mmHg vs(130±73)mmHg,(98.5±2.4)%vs(94.6±6.7)%,(289±137)mmHg vs(216±122)mmHg;T_(3)time point:(156±70)mmHg vs(86±17)mmHg,(98.2±1.3)%vs(96.0±2.9)%,(249±119)mmHg vs(143±32)mmHg](all P<0.05).After operation,the rates of acute lung injury and acute respiratory distress in observation group were lower than those in control group,and length of stay in observation group was shorter than that in control group(all P<0.05).Conclusion The combination of zero-balance ultrafiltration has a significant effect on perioperative lung protection in patients with acute type A aortic dissection.