冠状动脉搭桥术后早期支气管镜的临床观察.pdfVIP

580 Chin J Hemo~，2007；1 7(41 冠状动脉搭桥术后早期支气管镜的临床观察 董光茹，朱团结，范学朋 (武汉亚洲心脏病医院1CU，湖北武汉430022) 摘要：目的 探讨冠状动脉搭桥手术对气道的损伤和临床表现。方法 前瞻性，连续病例临床研究，选择非体外循 环冠状动脉搭桥(off-pump CABG)患者(n=50)，术前无先天性心脏病，同术期无心功能衰竭，无肺炎、肺不张、肺梗 塞。通过纤维支气管镜观察气管-支气管形态，x线胸片观察肺和纵隔影像，检测呼吸道阻力、肺顺应性、呼吸指数 和动脉血气，以分析呼吸功能变化；检测体温、血常规、肝．肾功能等以了解其它器官功能状态。结果 气道水肿患者 1 3例(26％)，轻．中度气道水肿占l0例(20％)，重度气道水肿占3例(6％k气道水肿患者与气道无水肿患者比较：呼吸 道阻力显著性增加，肺顺应性、呼吸指数显著性降低，低氧血症的发生率增高，P0．05。重度气道水肿患者出现低氧 血症，需延长正压通气，可给予加压而罩经鼻持续正压通气。结论 off-pump CABG术后早期存在气道水肿，并导致呼 吸功能损害和低氧血症；支气管镜检查可及时发现重度呼吸道水肿，及时指导临床实施无创正压通气治疗。 关键词：冠状动脉搭桥；气道水肿；低氧血症；心脏手术 中图法分类号：R654．2 文献标识码：A 文章编号：1009—881X(2007)04—0580—03 Bronchoscopic Observation Early Following Bypass Operation of Coronary Artery DONG Guang—ru,ZHU Tuan-jie,FANXue-peng (ICU，Wuhan Asia Heart Hospital，Wuhan 430022，China) Abstract：Objective To determine the airway injury and clinical manifestation following coronary artery bypass graft(CABG)．Methods Prospective clinical study．50 consecutive patients undergoing off-pump CABG without congenital heart disease，perioperative heart failure，pneumonia，atelectasis and pulmonary infarction were chosen．Changes of trachea—bronchia were observed through bronchofibroscope，changes of lung and mediastina were observed through chest X—ray．Datas of airway resistance，lung compliance and spiro—index were collected to evaluate pulmonary function．Liver and renal function tests were collected to evaluate the functions ofthese organs． And ejection fraction，temperature，blood—routine were collected．Results 1 3 cases(26％)suffered from tracheo- bronchial edema，l 0 cases(20％)with tracheobronchial edema，3 cases(6％)SUffered with severe tracheobronchial edema．Airway res