發(fā)布時間：2018-08-18 08:24

【摘要】：目的：觀察心臟瓣膜置換術患者術中不同階應用等劑量(1 MAC)的七氟醚對圍術期心肺功能的影響,探討七氟醚實施心肺保護作用的最佳時機與方式。方法：擇期行心臟瓣膜置換術成年患者100例,隨機分成對照組(CON組)、七氟醚全程處理組(SEV組)、七氟醚預處理組(PRE組)和七氟醚后處理組(POS組)。分別在手術開始前(T1)、術畢(T2)、術后4h (T3)、8h (T4)、24 h (T5)和72h(T6)六個時點采血測定cTnI和BNP的濃度；手術開始前(t1)、手術結束即刻(t2)、術后2h(t3)、6 h(t4)和拔出氣管導管前30 min(t5)采血行血氣分析,記錄呼吸機相關參數(shù),計算M指數(shù)(PaO2/PAO2)、呼吸指數(shù)(RI)、氧合指數(shù)(OI)、肺內(nèi)分流率(Qs/Qt)及肺動/靜態(tài)順應性(Cd/Cs)；并記錄術后ICU停留時間、機械通氣時間、患者帶氣管導管時間、住院天數(shù)、術后不良事件以及隨訪18個月患者死亡率；對比術前及術后3個月超聲心動圖結果。結果：四組患者cTnI比較具有統(tǒng)計學意義(P0.01),而BNP、不良事件及四組間術后超聲心動圖改變無統(tǒng)計學差異(P0.05)；術后與CON組比較,SEV、PRE、POS組患者在t2-t5時刻的肺功能指標比較具有統(tǒng)計學意義(P0.05),而SEV組優(yōu)于PRE、POS組(P0.05)；術后呼吸機支持時間、患者帶氣管導管時間及ICU滯留時間與CON組比較,SEV、PRE、POS組患者均縮短(P0.05),而SEV組短于PRE、POS組(P0.05)；術后呼吸系統(tǒng)并發(fā)癥例數(shù)七氟醚處理組少于對照組(P0.05)：CON組患者的術后長期死亡率顯著高于其他三組(P0.05),SEV組與PRE、POS組比較無顯著性差異(P0.05),術后短期死亡率四組間比較無顯著性差異(P0.05)。結論：術中不同階段應用1MAC七氟醚對瓣膜置換術患者心肺具有保護作用,最佳方式為全程吸入七氟醚；而對心臟結構改變無影響,但對預后有一定的影響。
[Abstract]:Objective: to observe the effect of sevoflurane (1 MAC) on perioperative cardiopulmonary function in patients undergoing cardiac valve replacement, and to explore the best time and method for the cardiopulmonary protection of sevoflurane. Methods: 100 adult patients undergoing cardiac valve replacement were randomly divided into control group (CON group), sevoflurane whole course treatment group (SEV group), sevoflurane pretreatment group (PRE group) and sevoflurane post-treatment group (POS group). The concentrations of cTnI and BNP were measured at six time points: before operation (T1), after operation (T2), 4h (T3) 8h (T4) and 72h (T6), before operation (T1), at the end of operation (T2), 2 hours after operation (T3) at 6h (t4) and 30 min before tracheal catheter extraction (T5) for blood gas analysis. Ventilator related parameters were recorded, M index (PaO2/PAO2), (RI), oxygenation index (OI), intrapulmonary shunt rate (Qs/Qt) and pulmonary dynamic / static compliance (Cd/Cs) were calculated, and ICU residence time, mechanical ventilation time, trachea catheter time and hospitalization days were recorded. Postoperative adverse events and 18 months follow-up mortality were compared between preoperative and postoperative echocardiographic results. Results: there was significant difference in cTnI among the four groups (P0.01), but there was no significant difference in BNPs, adverse events and echocardiographic changes between the four groups (P0.05). Compared with the CON group, the pulmonary function indexes in the t2-t5 time group were significantly higher than those in the SEV group (P0.05), and the time of ventilator support after operation was significantly higher in the SEV group than in the PREPO-POS group (P0.05), and the time of postoperative ventilator support was significantly higher in the SEV group than in the SEV group (P0.05). Compared with the CON group, the trachea catheter time and ICU retention time in the SEV group were significantly shorter than those in the CON group (P 0.05), while those in the SEV group were shorter than those in the SEV group (P0.05). The number of postoperative respiratory complications in sevoflurane treated group was less than that in control group (P0.05). The long-term mortality of sevoflurane group was significantly higher than that of other three groups (P0.05). There was no significant difference between SEV group and PREPO-POS group (P0.05), and there was no significant difference in short-term mortality among four groups (P0.05). Conclusion: 1MAC sevoflurane has protective effect on heart and lung of patients with valvular replacement at different stages during operation, the best way is to inhale sevoflurane in the whole course, but it has no effect on the change of cardiac structure, but it has certain influence on prognosis.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614
，

本文編號：2188923