【摘要】：目的：研究比較甲潑尼龍和地塞米松對體外循環(huán)(cardiopulmonary bypass,CPB)下心臟瓣膜置換術(shù)患者肺功能的影響。 方法：將60例在CPB下行心臟瓣膜置換術(shù)的患者隨機分為地塞米松組(A組)30例和甲潑尼龍組(B組)30例。在麻醉誘導(dǎo)氣管插管后A組患者從中心靜脈靜注地塞米松0.5mg/kg, B組患者從中心靜脈靜注甲潑尼龍10mg/kg。在轉(zhuǎn)機前(T1)、注射魚精蛋白30min (T2)、手術(shù)結(jié)束時(T3)、術(shù)后2小時(T4)、拔除氣管導(dǎo)管前(T5)抽取動脈血行血氣分析,記錄動脈血二氧化碳分壓(PaC02)和動脈血氧分壓(PaC02)值,并記錄各時間點的吸入氧濃度(Fi02),根據(jù)公式計算肺泡-動脈氧分壓差(A-aD02)、呼吸指數(shù)(Respiratory Index,RI)和氧合指數(shù)(Oxygenation index,OI),記錄患者的術(shù)后帶管時間、CCU監(jiān)護時間及術(shù)后肺部并發(fā)癥情況。 結(jié)果：在T1時點,兩組的Pa02的差異無統(tǒng)計學(xué)意義(P＞0.05)；在T2-5時點,B組的Pa02高于A組(P0.05)。兩組的A-aDO2、RI、OI在T,差異均無統(tǒng)計學(xué)意義(P＞0.05)；在T2-5,兩組的A-aDO2、RI、OI有明顯差異,B組的A-aDO2和RI均低于A組(P0.05),B組的OI高于A組(PO.05)；兩組的A-aDO2、RI在T1～5均呈先升高后下降的趨勢,兩組的OI在T1-5均呈先下降后升高的趨勢；B組的術(shù)后帶管時間與術(shù)后肺部并發(fā)癥發(fā)生率均低于A組(P＜0.05)；兩組的CCU監(jiān)護時間差異無統(tǒng)計學(xué)意義(P＞0.05)。 結(jié)論：1、CPB后患者的肺彌散功能和氧交換功能受損,表現(xiàn)為CPB后A-aDO2、RI升高,OI下降；2、甲潑尼龍較地塞米松對體外循環(huán)心臟瓣膜置換術(shù)患者有更好的肺功能保護作用。
[Abstract]:Aim: to compare the effects of methylprednisolone and dexamethasone on pulmonary function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (cardiopulmonary bypass,CPB). Methods: 60 patients undergoing cardiac valve replacement with CPB were randomly divided into dexamethasone group (group A) and methylprednisolone group (group B). Group A received dexamethasone 0.5 mg / kg via central vein and group B received methylprednisolone 10 mg / kg via central vein after anesthesia induced endotracheal intubation. Before transposition (T1), injection of protamine 30min (T2), end of operation (T3), 2 hours after operation (T4), extraction of arterial blood (T5) before removal of trachea catheter for blood gas analysis, The arterial partial pressure of carbon dioxide (PaC02) and arterial partial pressure of oxygen (PaC02) were recorded. The inhaled oxygen concentration (Fi02) at each time point was recorded. The alveolar arterial oxygen pressure difference (A-aD02) and respiratory index (Respiratory Index,) were calculated according to the formula. RI) and oxygenation index (Oxygenation index,OI) were used to record the time of tubing, monitoring time of CCU and postoperative pulmonary complications. Results: at T1, there was no significant difference in Pa02 between the two groups (P > 0. 05), while at T2-5, the Pa02 of group B was higher than that of group A (P0.05). There was no significant difference between the two groups (P > 0.05). In T2-5, there was a significant difference between the two groups in A-aDO2RII-OI, the A-aDO2 and RI in group B were lower than those in group A (P0.05) OI in), B group was higher than that in group A (PO.05). In both groups, the RI of A-aDO2T1-5 increased first and then decreased, the OI in T1-5 decreased at first and then increased in T1-5, the postoperative time of tubing and the incidence of postoperative pulmonary complications in group B were lower than those in group A (P < 0. 05), and the incidence of postoperative pulmonary complications in group B was lower than that in group B (P < 0. 05). There was no significant difference in CCU monitoring time between the two groups (P > 0. 05). Conclusion: 1 the pulmonary diffusion function and oxygen exchange function were impaired after CPB, which showed that A-aDO2RI increased and OI decreased after CPB. 2. Methylprednisolone has better protective effect on pulmonary function than dexamethasone on cardiopulmonary bypass patients undergoing cardiac valve replacement.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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