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吸入氧气度对肺气体交换的作用 在外冠状动脉绕道接种过程中
I Begashvili1, M Kiladze2, G Grigolia3
11Tbilisi 5th Clinical Hospital, Department of Cardiac Anesthesia and Intensive Care, Ivane Javakhishvili Tbilisi State University, Georgia.
Georgian medical news
|December 14, 2023
概括
在非抽冠状动脉旁路移植 (OPCABG) 手术期间,在0.8的高吸入氧 (FiO2) 分数下进行呼吸的患者,会比0.5.5的较低FiO2更严重地损害肺气交换. 对于接受OPCABG的患者来说,较低的FiO2似乎更安全.
科学领域:
- 麻醉学 麻醉学
- 心胸外科手术 心胸外科手术
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 心脏手术期间高分量吸入氧气 (FiO2) 的目的是防止缺氧,但可以恶化肺气交换.
- 升高的FiO2可能会导致脱氧化和增加肺突变分数.
- 像PaO2/FiO2,P(a-Et) CO2和PEtCO2/PaCO2这样的变量反映了气体交换受损的情况.
研究的目的:
- 评估不同FiO2水平在非抽冠状动脉旁路移植 (OPCABG) 期间对肺气交换的影响.
- 为了比较FiO2 0.8与FiO2 0.5在OPCABG期间对氧气和二氧化碳交换的影响.
主要方法:
- 接受OPCABG的70名患者被随机分为两个组:高FiO2 (0.8) 和低FiO2 (0.5).
- 肺气交换参数 (PaO2/FiO2,P(a-Et) CO2梯度,PEtCO2/PaCO2比率) 在手术开始和结束时进行测量.
- 血液动力学数据,实验室结果,机械通风持续时间和ICU停留时间在各组之间进行了比较.
主要成果:
- 两组患者的PaO2/FiO2均降低,P(a-Et) CO2均增加,PEtCO2/PaCO2从手术开始到结束均降低.
- 在手术结束时观察到统计学上显著的差异:PaO2/FiO2较低 (290±63对 326±65,p=0.020),P(a-Et) CO2较高 (7.5±2.4对 5.7±2.3 mmHg,p=0.003),PEtCO2/PaCO2较低 (0.80±0.06对 0.84±0.05,p=0.001) 在高FiO2组.
- 在血液动力学数据,实验室值,通风持续时间或ICU停留时间方面没有发现显著差异.
结论:
- 在OPCABG期间使用FiO2 0.8进行通风,导致肺气交换的变化比FiO2 0.5.5更大.
- 虽然FiO2没有影响研究的临床结果,但使用FiO20.5似乎是接受OPCABG的患者更安全的策略.
- 较低的FiO2可能会减轻脱氧和分离分数,在OPCABG期间保持更好的气体交换.
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