肢体远隔缺血预处理对心肺转流心脏瓣膜置换术患者肺功能的影响

摘要

Objective To evaluate the effect of limb remote ischaemic preconditioning on pul-monary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary by-pass.Methods Seventy patients,32 males and 38 females,aged 18-70 years,weighing 45-90 kg, ASA physical status Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement surgery with cardiopul-monary bypass,were divided into 2 groups using a random number table,35 in each group.Patients in group R received three cycles of right upper-limb 5 min ischemia (blood-pressure cuff inflation to≥ 200 mm Hg)and 5 min reperfusion (blood-pressure cuff deflation to 0 mm Hg)at 10 min after in-tubation.In group C,the cuff was placed around the arm but not inflated.At 10 min after intubation (T0),at 1 h after aortic declamping (T1)and at 6 h (T2),12 h (T3),24 h (T4)after surgery,arte-rial blood was sampled to conduct gas analysis,PaO2/FiO2ratio and alveolar-arterial oxygen gradient (A-aDO2)were calculated,and the dynamic lung compliance (Cd)and static lung compliance (Cs) were also recorded.The occurrence of pulmonary adverse events was recorded until discharge. Results Compared with T0,PaO2/FiO2was decreased in the two groups at T1-T4,A-aDO2was de-creased at T2-T4,Cs and Cd were increased in group C at T3,and were increased in group R at T2, T3(P<0.05).Compared with group C,the Cs and Cd at T2,T3were increased in group R.There were no significant differences between the two groups in the PaO2/FiO2,A-aDO2at T0-T4.The oc-currence of the pulmonary adverse events was decreased significantly in group R than in group C (P<0.05).The occurrence of pulmonary adverse events was declined significantly in group R than in group C (P<0.05).Conclusion Limb remote ischemic preconditioning can improve the lung compli-ance and reduce the occurrence of the pulmonary adverse events in patients undergoing cardiac valve replacement surgery.%目的 评价肢体远隔缺血预处理(remote ischemic preconditioning,RIPC)对心肺转流(cardiopulmonary bypass,CPB)心脏瓣膜置换术患者肺功能的影响.方法 择期在 CPB下行心脏瓣膜置换术患者70 例,男32 例,女38 例,年龄 18~70 岁,体重45~90 kg,ASA Ⅱ或Ⅲ级,采用随机数字表法将患者分为两组,每组35 例.R组于气管插管后10 min采用测压袖带在患者右上肢上臂,给予 3 个循环的 5 min缺血(袖带充气,压力≥200 mm Hg)及5 min再灌注(袖带放气至0 mm Hg)处理.C组将袖带绑于患者右上肢,但不进行充气及放气操作.分别于气管插管后 1 0 min(T0)、主动脉开放后 1 h(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)采集桡动脉血样,进行血气分析,计算氧合指数(PaO2/FiO2)和肺泡动脉血氧分压差(A-aDO2),肺动态顺应性(Cd)和肺静态顺应性(Cs).记录出院时肺部不良事件情况.结果 与 T0时比较,T1~T4时两组 PaO2/FiO2明显降低,T2~T4时A-aDO2明显降低,T3时C组Cs、Cd明显升高,T2、T3时 R组Cs、Cd明显升高(P<0.05).与 C组比较,T2、T3时 R组 Cs、Cd 明显提高,T0~T4时 PaO2/FiO2、A-aDO2两组差异无统计学意义.与C组比较,R组肺部不良事件发生率明显降低(P<0.05 ).结论 肢体远隔缺血预处理能够改善心脏瓣膜置换术患者的肺顺应性,减少术后肺部不良事件的发生.