Increased pulmonary capillary permeability and extravascular lung water after major vascular surgery: effect on radiography and ventilatory variables
Increased pulmonary capillary permeability and extravascular lung water after major vascular surgery: effect on radiography and ventilatory variables
复制标题
DOI：
10.1017/s0265021505001730
复制
发表时间：
2006-01-01
影响因子：
3.6
通讯作者：
Rauwerda, JA
中科院分区：
文献类型：
--
作者：
Groeneveld, ABJ;Verheij, J;Rauwerda, JA
前言：我们决定探讨大血管手术后患者肺通气和影像学异常的发病机制。患者与方法：对16例无心衰机械通气的腹部大手术后3 h内患者进行研究。我们测量了血管外肺水、胸内、舒张末期和肺血容量、ga -67转铁蛋白肺漏指数以及通气和放射学变量。后者允许计算肺损伤评分作为肺损伤的衡量标准。结果：16例患者中5例肺血管外水升高（bbb7 mL kg(-1)）， 11例肺漏指数升高，肺血管外水异常伴高肺漏指数及相对于胸内血容量或肺血容量的高血管外肺水。患者被随机分为肺损伤评分为>.1和1分与机械通气持续时间较长相关的两组。结论：我们的数据表明，轻微的、亚临床的肺水肿在大血管手术后相对常见，主要是由于肺毛细血管通透性增加而没有明显的心力衰竭。然而，通透性水肿仅部分影响术后肺损伤评分和机械通气需求，提示肺不张是主要因素。
Introduction: We decided to investigate the pathogenesis of pulmonary ventilatory and radiographic abnormalities in patients after major vascular surgery. Patients and methods: Sixteen mechanically ventilated patients without heart failure were studied, within 3 h after major abdominal surgery. We measured extravascular lung water, intrathoracic, global end-diastolic and pulmonary blood volumes, Ga-67-transferrin pulmonary leak index and ventilatory and radiographic variables. The latter allowed computation of the lung injury score as a measure of lung injury. Results: The extravascular lung water was elevated ( > 7 mL kg(-1)) In 5 of 16 patients, while the pulmonary leak index was elevated in 11 patients and a supranormal extravascular lung water was associated with a high pulmonary leak index and higher extravascular lung water relative to intrathoracic blood volume or pulmonary blood volume. Patients were arbitrarily divided into those with a lung injury score > 1 and 1 was associated with a longer duration of mechanical ventilation. Conclusion: Our data suggest that mild, subclinical, pulmonary oedema is relatively common after major vascular surgery, mainly caused by increased pulmonary capillary permeability in the absence of overt heart failure. However, permeability oedema only partially contributes to postoperative lung injury score and need for mechanical ventilation, suggesting a major contribution by atelectasis.