心脏瓣膜置换术中不同阶段应用等剂量七氟醚的心肺功能的影响
发布时间：2018-08-18 08:24
【摘要】：目的：观察心脏瓣膜置换术患者术中不同阶应用等剂量(1 MAC)的七氟醚对围术期心肺功能的影响,探讨七氟醚实施心肺保护作用的最佳时机与方式。方法：择期行心脏瓣膜置换术成年患者100例,随机分成对照组(CON组)、七氟醚全程处理组(SEV组)、七氟醚预处理组(PRE组)和七氟醚后处理组(POS组)。分别在手术开始前(T1)、术毕(T2)、术后4h (T3)、8h (T4)、24 h (T5)和72h(T6)六个时点采血测定cTnI和BNP的浓度；手术开始前(t1)、手术结束即刻(t2)、术后2h(t3)、6 h(t4)和拔出气管导管前30 min(t5)采血行血气分析,记录呼吸机相关参数,计算M指数(PaO2/PAO2)、呼吸指数(RI)、氧合指数(OI)、肺内分流率(Qs/Qt)及肺动/静态顺应性(Cd/Cs)；并记录术后ICU停留时间、机械通气时间、患者带气管导管时间、住院天数、术后不良事件以及随访18个月患者死亡率；对比术前及术后3个月超声心动图结果。结果：四组患者cTnI比较具有统计学意义(P0.01),而BNP、不良事件及四组间术后超声心动图改变无统计学差异(P0.05)；术后与CON组比较,SEV、PRE、POS组患者在t2-t5时刻的肺功能指标比较具有统计学意义(P0.05),而SEV组优于PRE、POS组(P0.05)；术后呼吸机支持时间、患者带气管导管时间及ICU滞留时间与CON组比较,SEV、PRE、POS组患者均缩短(P0.05),而SEV组短于PRE、POS组(P0.05)；术后呼吸系统并发症例数七氟醚处理组少于对照组(P0.05)：CON组患者的术后长期死亡率显著高于其他三组(P0.05),SEV组与PRE、POS组比较无显著性差异(P0.05),术后短期死亡率四组间比较无显著性差异(P0.05)。结论：术中不同阶段应用1MAC七氟醚对瓣膜置换术患者心肺具有保护作用,最佳方式为全程吸入七氟醚；而对心脏结构改变无影响,但对预后有一定的影响。
[Abstract]:Objective: to observe the effect of sevoflurane (1 MAC) on perioperative cardiopulmonary function in patients undergoing cardiac valve replacement, and to explore the best time and method for the cardiopulmonary protection of sevoflurane. Methods: 100 adult patients undergoing cardiac valve replacement were randomly divided into control group (CON group), sevoflurane whole course treatment group (SEV group), sevoflurane pretreatment group (PRE group) and sevoflurane post-treatment group (POS group). The concentrations of cTnI and BNP were measured at six time points: before operation (T1), after operation (T2), 4h (T3) 8h (T4) and 72h (T6), before operation (T1), at the end of operation (T2), 2 hours after operation (T3) at 6h (t4) and 30 min before tracheal catheter extraction (T5) for blood gas analysis. Ventilator related parameters were recorded, M index (PaO2/PAO2), (RI), oxygenation index (OI), intrapulmonary shunt rate (Qs/Qt) and pulmonary dynamic / static compliance (Cd/Cs) were calculated, and ICU residence time, mechanical ventilation time, trachea catheter time and hospitalization days were recorded. Postoperative adverse events and 18 months follow-up mortality were compared between preoperative and postoperative echocardiographic results. Results: there was significant difference in cTnI among the four groups (P0.01), but there was no significant difference in BNPs, adverse events and echocardiographic changes between the four groups (P0.05). Compared with the CON group, the pulmonary function indexes in the t2-t5 time group were significantly higher than those in the SEV group (P0.05), and the time of ventilator support after operation was significantly higher in the SEV group than in the PREPO-POS group (P0.05), and the time of postoperative ventilator support was significantly higher in the SEV group than in the SEV group (P0.05). Compared with the CON group, the trachea catheter time and ICU retention time in the SEV group were significantly shorter than those in the CON group (P 0.05), while those in the SEV group were shorter than those in the SEV group (P0.05). The number of postoperative respiratory complications in sevoflurane treated group was less than that in control group (P0.05). The long-term mortality of sevoflurane group was significantly higher than that of other three groups (P0.05). There was no significant difference between SEV group and PREPO-POS group (P0.05), and there was no significant difference in short-term mortality among four groups (P0.05). Conclusion: 1MAC sevoflurane has protective effect on heart and lung of patients with valvular replacement at different stages during operation, the best way is to inhale sevoflurane in the whole course, but it has no effect on the change of cardiac structure, but it has certain influence on prognosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
，
本文编号：2188923
[Abstract]:Objective: to observe the effect of sevoflurane (1 MAC) on perioperative cardiopulmonary function in patients undergoing cardiac valve replacement, and to explore the best time and method for the cardiopulmonary protection of sevoflurane. Methods: 100 adult patients undergoing cardiac valve replacement were randomly divided into control group (CON group), sevoflurane whole course treatment group (SEV group), sevoflurane pretreatment group (PRE group) and sevoflurane post-treatment group (POS group). The concentrations of cTnI and BNP were measured at six time points: before operation (T1), after operation (T2), 4h (T3) 8h (T4) and 72h (T6), before operation (T1), at the end of operation (T2), 2 hours after operation (T3) at 6h (t4) and 30 min before tracheal catheter extraction (T5) for blood gas analysis. Ventilator related parameters were recorded, M index (PaO2/PAO2), (RI), oxygenation index (OI), intrapulmonary shunt rate (Qs/Qt) and pulmonary dynamic / static compliance (Cd/Cs) were calculated, and ICU residence time, mechanical ventilation time, trachea catheter time and hospitalization days were recorded. Postoperative adverse events and 18 months follow-up mortality were compared between preoperative and postoperative echocardiographic results. Results: there was significant difference in cTnI among the four groups (P0.01), but there was no significant difference in BNPs, adverse events and echocardiographic changes between the four groups (P0.05). Compared with the CON group, the pulmonary function indexes in the t2-t5 time group were significantly higher than those in the SEV group (P0.05), and the time of ventilator support after operation was significantly higher in the SEV group than in the PREPO-POS group (P0.05), and the time of postoperative ventilator support was significantly higher in the SEV group than in the SEV group (P0.05). Compared with the CON group, the trachea catheter time and ICU retention time in the SEV group were significantly shorter than those in the CON group (P 0.05), while those in the SEV group were shorter than those in the SEV group (P0.05). The number of postoperative respiratory complications in sevoflurane treated group was less than that in control group (P0.05). The long-term mortality of sevoflurane group was significantly higher than that of other three groups (P0.05). There was no significant difference between SEV group and PREPO-POS group (P0.05), and there was no significant difference in short-term mortality among four groups (P0.05). Conclusion: 1MAC sevoflurane has protective effect on heart and lung of patients with valvular replacement at different stages during operation, the best way is to inhale sevoflurane in the whole course, but it has no effect on the change of cardiac structure, but it has certain influence on prognosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
，
本文编号：2188923
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