摘要
目的观察呼气末正压(PEEP)通气对非体外循环冠脉分流移植术(OPCABG)氧代谢的影响。方法选择OPCABG患者20例,随机分为实验组(5cmH2OPEEP组,n=10)和对照组(0cmH2OPEEP组,n=10)。所有手术患者均实施常规麻醉诱导和维持方式。桡动脉穿刺,中心静脉穿刺置管于右心房。记录切皮前、劈胸骨、心脏操作中、术毕,以及术后24h5个时间点的血流动力学和氧代谢指标,对两组差异进行统计学分析。结果两组一般情况以及术中用药比较无明显差异。血流动力学均有波动,波动幅度相近(P>0.05);实验组较对照组提高了术中氧供(P<0.01),且术后24h内动脉血乳酸浓度显著降低(P<0.01)。结论OPCABG术中使用5cmH2O的PEEP安全地改善了术中乃至术后24h组织氧合状态,并且能够减少机械通气带来的肺损伤以及术后肺部并发症发生。
Objective To examine the effects of positive end expiratory pressure （PEEP） on oxygen metabolism during off-pump coronary artery bypass grafting surgery, Methods Twenty off-pump coronary artery bypass grafting （OPCABG） patients were randomly divided into 2 groups：5 cmH2O PEEP group（n = 10） and the control group（n = 10）, All patients were operated under general anesthesia with the same inductive and maintenance methods, Radial artery was cannulated, Central-Venous catheter was placed via inter jugular vein into the right atrium. Hemodynamic and oxygen metabohsm parameters were measured and recorded before skin incision, when the sternum was ripped, during the operation on the heart, at the end of surgery and 24 hours after the operation, and statistically analyzed the difference between the two groups, Results The general state of the two groups before the operation and drug consumption during the operation had no remarkable difference. On the side of hemodynamics, the two groups had almost similar fluctuation, However, P group not only increased the oxygen delivery during the operation but also remarkably decreased the artery blood lactic acid 24 hours after the operation, Conclusion 5 cmH2O PEEP can be used safely under OPCABG, and can improve the oxygenation during the operation, or even 24 hours after the operation, Moreover it can reduce lung injury from mechanical ventilation and complications of lung after the operation.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2008年第2期251-253,共3页
Journal of China Medical University
关键词
呼气末正压通气
非体外循环冠脉分流移植术
氧代谢
positive end expiratory pressure
off-pump coronary artery bypass grafting
oxygen metabolism
