论文部分内容阅读
为探讨左心转流降主动脉瘤手术中致萎陷肺出血的因素，作者对１４例手术中萎陷肺有不同程度出血（Ａ组）和１４例手术中无肺出血（Ｂ组）的临床资料进行了回顾性分析。结果表明：Ａ、Ｂ两组在转流量、上肢血压及ＣＶＰ存在显著性差异，而在年龄、体重、左心转流时间及主动脉阻断时间、瘤体大小及肺粘连等方面无明显区别，但两组均未测左房压。鉴于上述发现，作者在Ｃ组（８例）进行了前瞻性临床研究，即维持每分钟转流量３５±３．１ｍｌ／ｋｇ，通过调节左房引流控制左房压在０．６７～２．００ｋＰａ（５～１５ｍｍＨｇ），结果Ｃ组即无肺出血发生，也无明显肺组织病理学改变。作者认为左心转流降主动脉瘤手术期间维持转流量大于每分钟３０ｍｌ／ｋｇ，控制左房压在上述范围，可保证合适的肺循环和体循环血流动力学，防止萎陷肺损伤。
In order to investigate the factors of causing traumatic pulmonary hemorrhage during left aortic bypass in aortic aneurysm surgery, the authors studied 14 patients with collapsed lung with varying degrees of hemorrhage (group A) and 14 without pulmonary hemorrhage (group B) Clinical data were retrospectively analyzed. The results showed that there was a significant difference between A and B in the flow volume, upper limb blood pressure and CVP, but there was no significant difference in age, body weight, left ventricular bypass time, aortic occlusion time, tumor size and pulmonary adhesion , But left atrial pressure was not measured in both groups. In view of the above findings, the authors conducted a prospective clinical study in group C (n = 8), which maintained a mean flow volume of 35 ± 3.1 ml / kg per minute and controlled left atrial pressure at 0.67 to 2.00 kPa (5 ~ 15mmHg), the results of C group that no pulmonary hemorrhage, no significant pathological changes in lung tissue. The authors believe that the left aortic bypass of aortic aneurysm during the operation to maintain the turnover of more than 30ml / kg per minute, the control of left atrial pressure in the above range, to ensure proper pulmonary circulation and systemic hemodynamics, prevent collapse of lung injury.