血浆胶体渗透压对体外循环后急性肺损伤的影响.docVIP

血浆胶体渗透压对体外循环后急性肺损伤的影响 陈志斌 金孝梁 王敏燕 吕佳 李丽娟 张薇薇 （解放军第117医院麻醉科 杭州 310013） 【摘要】目的 研究心脏外科手术期间血浆胶体渗透压变化与体外循环后急性肺损伤的关系，探讨维持体外循环期间合理的血浆胶体渗透压（COP）水平。方法 对136例体外循环下接受心脏外科手术的患者，每30分钟检测COP一次，以麻醉前至体外循环前COP平均值为体外循环前COP值，体外循环开始至结束平均值为体外循环期间COP值，体外循环结束至手术结束平均值为体外循环后COP值。以术后24小时内出现PaO2 /FiO2 300mmHg和X线胸片显示有双肺浸润影，同时排除心源性肺水肿，诊断为体外循环后急性肺损伤。分析COP与体外循环后急性肺损伤发生率的关系。结果 符合体外循环后急性肺损伤诊断49例，体外循环前COP与急性肺损伤发生率无明显相关性，体外循环期间和体外循环后COP与急性肺损伤发生率有显著相关性（r=-0.810,p=0.011；r=-0.733,p=0.039）。结论 体外循环后急性肺损伤是心脏外科手术的常见并发症。体外循环导致心脏外科手术患者COP明显下降，并持续到手术结束，COP显著减低增加肺损伤的发生率。 【关键词】 血浆胶体渗透压；体外循环；急性肺损伤；氧合指数 The effect of plasma colloid osmotic pressure during the perioperative period on the lung injury after cardiac surgical operation Chen zhibin, Jin xiaoliang, Wang mingyan, et al. Department of Anesthesiology ,The PLA 117th Hospital , Hangzhou 310013，China 【Abstract】 Objective To study the relationship between changes of plasma colloid osmotic pressure (COP) during cardiac surgery under cardiopulmonary bypass (CPB) and postoperative acute lung injury, and explore the reasonable levels of plasma COP during CPB. Methods Measurements of plasma COP were made before, during and after CPB in 136 patients undergoing cardiac surgery under CPB. Postoperative acut-e lung injury was consi-dered according to the PaO2 / FiO2 300mmHg and X-ray showed bilateral pulmonary infiltrates within 24h after surgery, while excluding cardiogenic pulmonary edema. The rel-ationship between plasma COP and morbidity of postoperative acute lung injury was anal-yzed. Results Of the 136 patients, 49 cases had postoperative acute lung injury. There was no significant correlation between changes of plasma COP of pre-CPB and postoperative acute lung injury, while there were significant correlation between changes of plasma COP of CPB, post-CPB and postoperative acute lung injury (r = -0.810, p = 0.011 and r = -0.733, p = 0.039). Conclusions Postoperative acute lung injury is a common complication of cardiac surgery.The obvious decre