中国现代医生2024，Vol.62Issue(10)：22-27,6.DOI:10.3969/j.issn.1673-9701.2024.10.006
肺复张在急性A型主动脉夹层术后低氧血症中的应用
Effects of lung recruitment maneuver on postoperative hypoxemia in patients with acute type A aortic dissection
摘要
Abstract
Objective To explore the efficacy and safety of lung recruitment maneuver(LRM)on postoperative hypoxemia in patients with acute type A aortic dissection(ATAAD).Methods A total of 56 ATAAD patients with postoperative hypoxemia in the First Affiliated Hospital of Guangxi Medical University from November 2019 to May 2022 were selected and randomly divided into LRM group(n=36)and conventional treatment group(n=20).Patients in conventional treatment group received routine mechanical ventilation on the basis of lung protective ventilation.The patients in LRM group were treated with incremental positive end expiratory pressure(PEEP).Arterial blood gas analysis,respiratory parameters,hemodynamics parameters and serum interleukin(IL)-6 and IL-10 levels were compared between two groups before and after treatment.Results At 12h and 24h after treatment,arterial partial pressure of oxygen(PaO2),oxygenation index(OI),static compliance(Cstat)and dynamic compliance(Cdyn)in two groups were significantly higher than before treatment,the alveolar-arterial gradient of oxygen[PO2(A-a)],respiratory index(RI),peak inspiratory pressure(Ppeak)and plateau pressure(Pplat)were significantly lower than before treatment(P<0.05).PaO2,OI,Cstat and Cdyn in LRM group were significantly higher than those in conventional treatment group,PO2(A-a),RI,Ppeak and Pplat were significantly lower than those in conventional treatment group(P<0.05).Systolic blood pressure and mean arterial pressure decreased and central venous pressure increased during pulmonary reexpansion in LRM group(P<0.05),and all patients returned to baseline level after pulmonary reexpansion.At 12h after treatment,serum IL-6 and IL-10 levels in both groups were significantly lower than before treatment(P<0.05).Conclusion Incremental PEEP can improve oxygenation and lung compliance in patients with hypoxemia after ATAAD surgery,but it has transient effects on hemodynamics,and should be closely monitored during treatment.关键词
主动脉夹层/低氧血症/肺复张/呼气末正压通气Key words
Aortic dissection/Hypoxemia/Lung recruitment maneuver/Positive end expiratory pressure分类
医药卫生引用本文复制引用
刘阳春,李奇威,温建麟,陆海素,莫丽勤,曾晓春..肺复张在急性A型主动脉夹层术后低氧血症中的应用[J].中国现代医生,2024,62(10):22-27,6.基金项目
广西医疗卫生适宜技术开发与推广应用项目(S2019105) （S2019105）
