Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of bilateral internal mammary arteries
Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of bilateral internal mammary arteries
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DOI：
10.1016/s1010-7940(00)00438-3
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发表时间：
2000-07-01
影响因子：
3.4
通讯作者：
Taggart, DP
中科院分区：
文献类型：
--
作者：
Taggart, DP
背景：心肺旁路（CPB）对心脏手术后呼吸功能障碍的定量影响尚未记录，并且使用双侧乳内动脉（IMA）移植物的效果尚不清楚。方法：对 175 名接受 CABG 且有（CPB，n = 150）和无（NOCPB，n = 25）CPB 的患者进行了研究。测量PMN弹性蛋白酶（作为全身炎症反应的标志）和连续动脉氧（paO（2））和二氧化碳（paCO（2））张力、肺泡动脉氧（AaO（2））梯度和百分比饱和度。 CPB 组根据使用的 IMA 移植物数量分为三组：0IMA (n = 12)、1IMA (n = 82) 和 2IMA (n = 51)。结果：与 CPB 组相比，NOCPB 组更年轻，术前血气指标明显更好，接受的移植物更少，PMN 弹性蛋白酶水平更低。两组中最大呼吸功能障碍均发生在 48 小时（paO(2)、百分比饱和度和 Aa 梯度相对于基线均 P < 0.001），并在 5 天时部分恢复。 CPB 和 NOCPB 组中所有血气参数的下降百分比和随后的恢复几乎相同。在三个 IMA 组中，所有血气参数的百分比变化相似，术后通气持续时间和出院时间也相似。 48小时血气参数与年龄、体外循环时间、失血量、通气持续时间或峰值PMN弹性蛋白酶水平之间没有相关性。结论：尽管 PMN 弹性蛋白酶水平表明 CPB 产生更明显的炎症反应，但接受 CABG 且不进行 CPB 的患者术后气体交换的变化相似。与1IMA相比，使用2IMA不会增加呼吸功能障碍。 (C) 2000 Elsevier Science B.V. 保留所有权利。
Background: The quantitative contribution of cardiopulmonary bypass (CPB) to respiratory dysfunction after cardiac surgery is not documented and the effect of the use of bilateral internal mammary artery (IMA) grafts is not clear. Methods: One hundred and seventy-five patients undergoing CABG with (CPB, n = 150) and without (NOCPB, n = 25) CPB were studied. PMN elastase (as a marker of the systemic inflammatory response) and serial arterial oxygen (paO(2)) and carbon dioxide (paCO(2)) tension, alveolar arterial oxygen (AaO(2)) gradient and percent saturation were measured. The CPB group was subdivided into three groups by the number of IMA grafts used: 0IMA (n = 12), 1IMA (n = 82) and 2IMA (n = 51). Results: The NOCPB group was younger, had significantly better preoperative blood gases, received fewer grafts and had lower PMN elastase levels than the CPB group. In both groups maximum respiratory dysfunction occurred at 48 h (paO(2), percentage saturation and Aa gradient all P < 0.001 versus baseline) with partial recovery by 5 days. The percentage decline and subsequent recovery in all blood gas parameters was near identical in the CPB and NOCPB groups. Amongst the three IMA groups the percentage changes in all blood gas parameters were similar, as was the duration of postoperative ventilation and time to discharge. There was no correlation between blood gas parameters at 48 h with age, CPB time, blood loss, duration of ventilation or peak PMN elastase level. Conclusions: Changes in postoperative gas exchange are similar in patients undergoing CABG with and without CPB even although PMN elastase levels indicate that CPB produces a more marked inflammatory response. The use of 2IMA compared with 1IMA does not increase respiratory dysfunction. (C) 2000 Elsevier Science B.V. All rights reserved.