早期应用呼气末正压通气对搭桥术后 肥胖患者呼吸系统的影响

Effect of early positive end expiratory pressure on respiratory function in obese patients after coronary artery bypass grafting

摘要:

目的 探讨心脏术后早期应用呼气末正压通气对搭桥术后患者呼吸系统的辅助效果。方法 回顾性 分析2014 年1 月—2016 年12 月吉林大学第二医院在全身麻醉体外循环下实行冠状动脉旁路移植术的80 例患者， 术后早期给予呼气末正压（PEEP）（8 cmH2O）40 例作为观察组。同时随机选取同期常规PEEP（5 cmH2O）进 行压力支持的患者40 例作为对照组。比较两组早期的氧分压、二氧化碳分压、酸碱度、碳酸氢根及标准碱剩余， 两组初始潮气量、气道峰压、气道平均压、机械通气时间、再次调节PEEP 及氧浓度例数；两组并发症（肺水 肿、肺损伤、围术期呼吸功能不全、低血压、二次插管、气管切开）发生情况、收缩压、心率、ICU 停留时间。 结果 两组初始PEEP 比较，差异有统计学意义（P <0.05），两组术后第3 次血气分析（pH，PO2，PCO2，sBE， HCO3 -），再次调节PEEP 和氧浓度的例数、低血压发生例数、机械通气时间、ICU 停留时间，围术期呼吸功能 不全发生例数比较，差异有统计学意义（P <0.05）；而初始潮气量、气道峰压、气道平均压、收缩压、心率、肺 损伤、肺水肿，二次插管人数及气管切开人数比较，差异无统计学意义（P >0.05）。结论 心搭桥脏术后肥胖患 者早期给予较高PEEP 能取得较好的肺保护效果。

Abstract:

Objective To investigate the effect of early positive end expiratory pressure on respiratory function after coronary artery bypass graft. Methods A total of 80 patients undergoing coronary artery bypass grafting under general anesthesia from January 2014 to December 2016 were retrospectively analyzed. Exactly 40 patients with positive end expiratory pressure (PEEP) (8 cm H2O) were enrolled as observation group. Another 40 patients with conventional PEEP (5 cm H2O) were enrolled as control group. PO2, PCO2, pH, bicarbonate, standard base excess, initial tidal volume, peak airway pressure, mean airway pressure, mechanical ventilation time, and change of PEEP and oxygen concentration were recorded. Complications including pulmonary edema, lung injury, perioperative respiratory insufficiency, hypotension, two intubations, tracheotomy as well as systolic blood pressure, heart rate, and ICU stay time were identified. Results Initial PEEP, third postoperative blood gas analysis (pH, PO2, PCO2, sBE, CHCO3 -), frequency of readjusting PEEP and oxygen concentration, incidence of hypotension, mechanical ventilation time, ICU stay time, and perioperative respiratory dysfunction were dramatically different between the two groups (P < 0.05). No significant differences in the number of initial tidal volume, peak airway pressure, mean airway pressure, systolic blood pressure, heart rate, lung injury, pulmonary edema, the number of two intubation, and the number of tracheotomy were identified (P > 0.05). Conclusions Early high PEEP treatment exerts better lung protective effect for obese patients after coronary artery bypass graft.