RESPIRATORY DYSFUNCTION AFTER UNCOMPLICATED CARDIOPULMONARY BYPASS
RESPIRATORY DYSFUNCTION AFTER UNCOMPLICATED CARDIOPULMONARY BYPASS
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DOI：
10.1016/0003-4975(95)90029-2
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发表时间：
1993-11-01
影响因子：
4.6
通讯作者：
WHEATLEY, DJ
中科院分区：
文献类型：
--
作者：
TAGGART, DP;ELFIKY, M;WHEATLEY, DJ
呼吸功能障碍是众所周知的心脏手术并发症。为了量化简单的体外循环后其当前的发生率和严重程度，对 129 名左心室功能良好（左心室舒张末压 < 15 mm）的患者（年龄，59 +/- 8 岁（平均值 +/- 标准差））进行了动脉氧分压 (PaO2)、肺泡-动脉氧梯度 (AaO2) 和肺分流百分比 (%PSF) 的连续测量，通过无创技术测量Hg）接受孤立冠状动脉手术（第 1 组）和 30 名接受普通外科手术的患者（第 2 组）在手术前和术后第 1、第 2 和第 6 天进行了测量。第 1 组中需要长时间通气的患者被排除在进一步研究之外。第 1 组中，在术前和术后第二天，PaO2 明显下降 [89 +/- 11 与 57 +/- 9 mm Hg；p < 0.001]。 AaO2 梯度显着增加 [18 +/- 10 对比 50 +/- 11 mm Hg；p < 0.001)] 和 % PSF [3 +/- 1% 对比 19 +/- 6%； p < 0.001)] 术后第六天仅略有改善 [PaO2，67 +/- 11 mm Hg； AaO2，45 +/- 11 毫米汞柱； %PSF，15 +/- 4]。第 2 组患者的 PaO2 和 AaO2 梯度也有类似但不太严重的变化，第 6 天恢复到基线值。第 1 组患者的回归分析显示术后呼吸功能障碍与术前 AaO2 梯度受损之间的相关性较弱，但与年龄、性别、吸烟状况、纽约心脏协会状态、搭桥时间或胸膜囊侵犯没有相关性。为了确定心脏手术后呼吸功能障碍的持续时间，对另外 30 名患者（第 3 组）进行了连续 PaO2 和 AaO2 梯度测量，直至术后第六周。第 3 组患者表现出与第 1 组患者相似的早期呼吸功能损伤，但到术后第六周完全缓解。这项研究表明，即使在简单的心肺转流术后，呼吸功能障碍也很常见，而且常常很严重，但在术后第六周就会消失。呼吸功能障碍在大型普通手术后也很常见，但不太严重，并在术后第六天消失。
Respiratory dysfunction is a well-recognized complication of cardiac operations. To quantify its current incidence and severity after uncomplicated cardiopulmonary bypass, serial measurements of arterial oxygen tension (PaO2), alveolar-arterial oxygen gradient (AaO2), and percentage pulmonary shunt fraction (%PSF) measured by a noninvasive technique were made in 129 patients (age, 59 +/- 8 years (mean +/- standard deviation) with good left ventricular function (left ventricular end-diastolic pressure < 15 mm Hg) undergoing isolated coronary artery operations (group 1) and 30 patients undergoing general surgical procedures (group 2). Measurements were made before operation and on the first, second, and sixth postoperative days. Seven patients in group 1 who required prolonged ventilation were excluded from further study. In group 1, between the preoperative and second postoperative days, there was a marked fall in PaO2 [89 +/- 11 versus 57 +/- 9 mm Hg; p < 0.001] and a marked increase in the AaO2 gradient [18 +/- 10 versus 50 +/- 11 mm Hg; p < 0.001)] and % PSF [3 +/- 1% versus 19 +/- 6%; p < 0.001)] with only modest improvement by the sixth postoperative day [PaO2, 67 +/- 11 mm Hg; AaO2, 45 +/- 11 mm Hg; %PSF, 15 +/- 4]. There were similar but less severe changes in PaO2 and AaO2 gradients in group 2 patients, with a return to baseline values by day 6. Regression analysis in group 1 patients showed a weak correlation between postoperative respiratory dysfunction and preoperative impairment of the AaO2 gradient, but no correlation with age, sex, smoking status, New York Heart Association status, bypass time, or violation of the pleural sac(s). To determine the duration of respiratory dysfunction after cardiac surgery, serial PaO2 and AaO2 gradient measurements were continued until the sixth postoperative week in a further 30 patients (group 3). Group 3 patients demonstrated similar early impairment of respiratory function to group 1 patients but with complete resolution by the sixth postoperative week. This study demonstrates that respiratory dysfunction is both common and frequently severe even after uncomplicated cardiopulmonary bypass but resolves by the sixth postoperative week. Respiratory dysfunction is also common after a major general operation but is less severe and resolves by the sixth postoperative day.