甲泼尼龙和地塞米松对体外循环瓣膜置换术患者肺功能影响的比较

发布时间：2019-02-14 11:24

【摘要】：目的：研究比较甲泼尼龙和地塞米松对体外循环(cardiopulmonary bypass,CPB)下心脏瓣膜置换术患者肺功能的影响。方法：将60例在CPB下行心脏瓣膜置换术的患者随机分为地塞米松组(A组)30例和甲泼尼龙组(B组)30例。在麻醉诱导气管插管后A组患者从中心静脉静注地塞米松0.5mg/kg, B组患者从中心静脉静注甲泼尼龙10mg/kg。在转机前(T1)、注射鱼精蛋白30min (T2)、手术结束时(T3)、术后2小时(T4)、拔除气管导管前(T5)抽取动脉血行血气分析,记录动脉血二氧化碳分压(PaC02)和动脉血氧分压(PaC02)值,并记录各时间点的吸入氧浓度(Fi02),根据公式计算肺泡-动脉氧分压差(A-aD02)、呼吸指数(Respiratory Index,RI)和氧合指数(Oxygenation index,OI),记录患者的术后带管时间、CCU监护时间及术后肺部并发症情况。结果：在T1时点,两组的Pa02的差异无统计学意义(P＞0.05)；在T2-5时点,B组的Pa02高于A组(P0.05)。两组的A-aDO2、RI、OI在T,差异均无统计学意义(P＞0.05)；在T2-5,两组的A-aDO2、RI、OI有明显差异,B组的A-aDO2和RI均低于A组(P0.05),B组的OI高于A组(PO.05)；两组的A-aDO2、RI在T1～5均呈先升高后下降的趋势,两组的OI在T1-5均呈先下降后升高的趋势；B组的术后带管时间与术后肺部并发症发生率均低于A组(P＜0.05)；两组的CCU监护时间差异无统计学意义(P＞0.05)。结论：1、CPB后患者的肺弥散功能和氧交换功能受损,表现为CPB后A-aDO2、RI升高,OI下降；2、甲泼尼龙较地塞米松对体外循环心脏瓣膜置换术患者有更好的肺功能保护作用。
[Abstract]:Aim: to compare the effects of methylprednisolone and dexamethasone on pulmonary function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (cardiopulmonary bypass,CPB). Methods: 60 patients undergoing cardiac valve replacement with CPB were randomly divided into dexamethasone group (group A) and methylprednisolone group (group B). Group A received dexamethasone 0.5 mg / kg via central vein and group B received methylprednisolone 10 mg / kg via central vein after anesthesia induced endotracheal intubation. Before transposition (T1), injection of protamine 30min (T2), end of operation (T3), 2 hours after operation (T4), extraction of arterial blood (T5) before removal of trachea catheter for blood gas analysis, The arterial partial pressure of carbon dioxide (PaC02) and arterial partial pressure of oxygen (PaC02) were recorded. The inhaled oxygen concentration (Fi02) at each time point was recorded. The alveolar arterial oxygen pressure difference (A-aD02) and respiratory index (Respiratory Index,) were calculated according to the formula. RI) and oxygenation index (Oxygenation index,OI) were used to record the time of tubing, monitoring time of CCU and postoperative pulmonary complications. Results: at T1, there was no significant difference in Pa02 between the two groups (P > 0. 05), while at T2-5, the Pa02 of group B was higher than that of group A (P0.05). There was no significant difference between the two groups (P > 0.05). In T2-5, there was a significant difference between the two groups in A-aDO2RII-OI, the A-aDO2 and RI in group B were lower than those in group A (P0.05) OI in), B group was higher than that in group A (PO.05). In both groups, the RI of A-aDO2T1-5 increased first and then decreased, the OI in T1-5 decreased at first and then increased in T1-5, the postoperative time of tubing and the incidence of postoperative pulmonary complications in group B were lower than those in group A (P < 0. 05), and the incidence of postoperative pulmonary complications in group B was lower than that in group B (P < 0. 05). There was no significant difference in CCU monitoring time between the two groups (P > 0. 05). Conclusion: 1 the pulmonary diffusion function and oxygen exchange function were impaired after CPB, which showed that A-aDO2RI increased and OI decreased after CPB. 2. Methylprednisolone has better protective effect on pulmonary function than dexamethasone on cardiopulmonary bypass patients undergoing cardiac valve replacement.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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