天津医药

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七氟烷后处理对体外循环下心脏瓣膜置换术患者肺功能的影响

贺克强,潘建辉,谢志琼,王瑞婷   

  1. 安徽医科大学附属省立医院麻醉科
  • 收稿日期:2012-08-09 修回日期:2012-12-12 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 王瑞婷

Effects of Sevoflurane Postconditioning on Lung Function in Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass

HE Keqiang ,PAN Jianhui ,XIE Zhiqiong ,WANG Ruiting   

  1. Department of Anesthesiology, the Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
  • Received:2012-08-09 Revised:2012-12-12 Published:2013-07-15 Online:2013-07-15
  • Contact: WANG Ruiting

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摘要：

【摘要】 目的  评价七氟烷后处理对体外循环下(CPB)心脏瓣膜置换术患者肺功能的影响。方法  将行CPB下心脏瓣膜置换术的30例患者随机分为对照组(C组)和七氟烷后处理组(S组),每组15例。2组均用咪达唑仑、芬太尼、哌库溴铵维持麻醉。S组在主动脉开放前2min左右通过CPB机吸入2%的七氟烷,持续15min,C组不做处理。分别于麻醉前(T1),CPB前30min(T2),CPB后30min(T3),术后6h(T4)、12h(T5)和24h(T6)时,测定患者动脉血p(O2)、血氧饱和度(SaO2)、机械通气时的气道峰压(Ppeak)和气道平台压(Pplat),计算氧合指数(OI)、肺泡动脉氧分压差(AaDO2)、动态肺顺应性(Cdyn)和静态肺顺应性(Cstat)。结果   CPB后30min,S组SaO2、Cdyn高于C组,术后6h,S组OI、p(O2)、Cdyn和Cstat值均高于C组,术后12h、24h,AaDO2值低于C组(均P<0.05)。结论  CPB过程产生肺功能损害,七氟烷后处理对CPB心脏瓣膜置换术患者的肺功能有一定的保护作用。 

关键词: 氟烷, 麻醉药, 吸入, 心肺转流术, 呼吸功能试验, 心脏瓣膜假体植入

Abstract: [Abstract]   Objective   To investigate the effects of sevoflurane postconditioning on lung function in patients undergoing heart valve prosthesis implantation with cardiopulmonary bypass (CPB). Methods   Thirty patients, scheduled for heart valve prosthesis implantation, were randomly divided into control group (C, n=15) and sevoflurane postconditioning group (S,n=15). Anesthesia was maintained by intermittent intravenous injection of midazolam, fentanyl and pipecuronium. In group S, 2% sevoflurane was inhaled continuously for 15 min , 2 min before aortic unclamping. Blood samples were taken at 30 min before CPB (T2), 30 min after CPB (T3), 6 h (T4), 12 h (T5) and 24 h (T6) after operation. The values of p（O2）, SaO2, airway peak pressure (Ppeak) and airway plateau (Pplat) pressure during the time of mechanical ventilation were recorded. Oxygen index (OI), alveolar arterial oxygen tension difference (AaDO2), dynamic pulmonary compliance (Cdyn) and static pulmonary compliance (Cstat) were calculated. Results  Compared with group C, the values of SaO2 and Cdynwere significantly higher in group S after 30 min of CPB. The values of OI, p（O2）, Cdyn and Cstat were significantly higher in group S than those of group C after 6h of operation. The value of AaDO2 was significantly lower 12 h and 24 h after operation than that of group C (P < 0.05).Conclusion   CPB led to the lung injury. The sevoflurane postconditioning has a protective effect on lung function in patients undergoing cardiac valve replacement with CPB.

Key words: halothane, Anesthetics, inhalation, Cardiopulmonary bypass, respiratory function tests, Respiratory function test