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The Effect of Low Tidal Volume Ventilation on Pulmonary and Cardiac Function before and after Mitral Valve Replacement
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- Author:
- No author available
- Journal Title:
- JOURNAL OF CHINESE PHYSICIAN
- Issue:
- 5
- DOI:
- 10.3760/cma.j.issn.1008-1372.2005.05.004
- Key Word:
- 低潮气量;机械通气;心肺功能
Abstract： 目的以心输出量和肺换气功能为指标研究低潮气量通气对瓣膜置换病人心肺功能的影响.方法 30例择期行二尖瓣置换手术病人随机分成三组:常规(传统)潮气量组(组Ⅰ)、低潮气量常规频率组(组Ⅱ)和低潮气量高频率组(组Ⅲ).监测平均动脉压(MAP),放置飘浮导管监测心输出量(CO)和心指数(CI),平均肺动脉压(MPAP),肺毛细血管嵌压(PCWP),中心静脉压(CVP),体循环阻力指数(SVRI),肺循环阻力指数(PVRI).测定动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2),以及氧合指数(PaO2/FiO2),肺泡动脉氧分压差(PA-aO2),肺内分流量(QS/QT).结果在体外循环前(T2),常规潮气量组的心输出量(CO)低于低潮气量高频率组(P＜0.05).组II,体外循环后60min与比麻醉后体外循环前比,氧和指数(PaO2/FiO2)显著降低(P＜0.05),肺泡-动脉氧分压差(PA-aO2)和肺内分流量(QS/QT)显著增加(P＜0.05).组II与组I和组III相比,在体外循环后60min(T4),氧和指数显著降低(P＜0.05),肺泡-动脉氧分压差和肺内分流量显著增加(P＜0.05).结论低潮气量机械通气对循环功能无明显影响,并能保持良好通气.低潮气量常规频率通气不能减轻体外循环引起的肺换气功能损害.低潮气量高频率通气和常规潮气量通气能减轻或消除体外循环引起的早期肺换气功能损害.常规潮气量机械通气下降低心功能较差病人的心输出量.
- [1]K E, Hammermeister,C, Burchfiel,R, Johnson,etc.Identification of patients at greatest risk for developing major complications at cardiac surgery.[J].1990,82.
- [2]G D, Gale,S J, Teasdale,D E, Sanders,etc.Pulmonary atelectasis and other respiratory complications after cardiopulmonary bypass and investigation of aetiological factors.[J].1979,26(1).
- [3]K Y, Mustafa,M M, Nour,H, Shuhaiber,etc.Pulmonary function before and sequentially after valve replacement surgery with correlation to preoperative hemodynamic data.[J].1984,130.
- [4]W C, Scott,D C, Miller,A, Haverich,etc.Operative risk of mitral valve replacement: discriminant analysis of 1329 procedures.[J].1985,72.
- [5]张孝忠,张玉威,邓东安.风湿性二尖瓣狭窄患者肺功能与血流动力学相关分析[J].1998,(2).
- [6]A A, Fowler,R F, Hamman,J T, Good,etc.Adult respiratory distress syndrome: risk with common predispositions.[J].1983,98.
- [7]A, Tenling,T, Hachenberg,H, Tydén,etc.Atelectasis and gas exchange after cardiac surgery.[J].1998,89.
- [8]Magnusson Lennart,Zemgulis Vitas,Wicky Stephan,etc.Atelectasis Is a Major Cause of Hypoxemia and Shunt after Cardiopulmonary Bypass[J].1997.
- [9]M H, Kollef,T, Wragge,C, Pasque.Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation.[J].1995,107(5).
- [10]G, Hedenstierna,A, Strandberg,B, Brismar,etc.Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation.[J].1985,62.
- [11]Bakhos M,Blakeman BP,Chaney MA,etc.Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass.[J].2000,14(5).
- [12]Weisse A.B.,Nair S.V.,Jaferi G.A..Studies in Pericardial Function[J].1975,60(2).
- [13]B, Brismar,G, Hedenstierna,H, Lundquist,etc.Pulmonary densities during anesthesia with muscular relaxation--a proposal of atelectasis.[J].1985,62.