肺移植术中经肺动脉泵注前列地尔对合并肺动脉高压肺纤维化患者血流动力学、肺内分流及氧合的影响
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摘要
目的观察单肺通气肺移植术中经肺动脉泵注前列地尔对合并肺动脉高压肺纤维化的患者血流动力学、肺内分流及氧合的影响。方法选择择期拟接受非体外循环下单肺移植术的合并肺动脉高压肺纤维化的患者50例,随机分为对照组(C组)和前列地尔组(P组),每组25例。在双肺通气置入漂浮导管后,P组以5 ng/(kg·min)经肺动脉泵注前列地尔,至供肺的肺动脉开放前停止泵注; C组泵注等量生理盐水,其余处理相同。在经肺动脉泵注前列地尔前(T1)及泵注后单肺通气10 min(T2)、15 min(T3)、30 min(T4)、45 min(T5)及60 min(T6)时,比较两组HR、MAP、Pa O2、Pa CO2、肺动脉压力(PAP)、外周血管阻力(SVR)、气道压力(Paw)、肺动态顺应性(Cldyn)、肺血管阻力(PVR)、肺内分流率(Qs/Qt)。结果与同组T1时相比,T2～T6时P组Pa O2、PAP、Clydn、PVR降低,Pa CO2、Paw、Qs/Qt升高(P均<0. 05)。与同组T1时相比,T2～T6时C组Pa O2、Clydn降低且Pa CO2、Paw、Qs/Qt升高,T3～T6时PAP、PVR升高(P均<0. 05)。与C组同时点相比,T3～T6时P组Pa O2高,PAP、SVR、PVR、Qs/Qt低(P均<0. 05)。结论合并肺动脉高压肺纤维化的患者在肺移植术中单肺通气时,经肺动脉泵注前列地尔,能在降低PAP、改善右心功能的基础上,减少肺内分流并改善氧合,提高肺移植患者围麻醉期的安全性。
Objective To observe the effects of alprostadil pump infusion through pulmonary artery on the lung ventilation( OLV) of patients with pulmonary hypertension( PH) in pulmonary transplantation. Methods Fifty patients who underwent off-pump lung transplantation for pulmonary fibrosis( PF) and PH were randomized into the control group( group C,n = 25) and alprostadil group( group P,n = 25). After placement of floating catheter for the double lung ventilation( DLV),patients in the group P received alprostadil pump infusion through the pulmonary artery at the dose of 5 ng/( kg·min) until the opening of the pulmonary artery. The patients in the group C received pump infusion with the equal volume of saline,and the remaining treatment was the same as that of the group P. Hemodynamics and gas exchange data before pulmonary arterial pumping of prostaglandin E1( PGE1)( T1),and 10 min( T2),15 min( T3),30 min( T4),45 min( T5),and 60 min( T6) of OLV after pump injection were observed. Hemorheology( HR),including arterial pressure( MAP),Pa O2,Pa CO2,pulmonary artery pressure( PAP),cardiac output,pulmonary vascular resistance( PVR),systemic vascular resistance( SVR),intrapulmonary shunt,Paw airway pressure( Paw),and dynamic lung compliance( Cldyn) were recorded. Results In the group P,the Pa O2,PAP,Clydn,and PVR significantly decreased after 10 min ventilation( P < 0. 05),however,Pa CO2,Paw,and Qs/Qt significantly increased( all P < 0. 05). In group C,after 10 min ventilation,the Pa O2 and Clydn significantly decreased,while Pa CO2,Paw,and Qs/Qt significantly increased( all P< 0. 05). The PAP and PVR significantly decreased after 20 min ventilation( P < 0. 05). When we compared the two groups simultaneously,except for the higher Pa O2,the other indicators were lower in the group P than in the group C after20 min ventilation( all P < 0. 05). Conclusion The alprostadil pump infusion through pulmonary artery on patients with pulmonary fibrosis and hypertension in lung transplantation,on the basis of reducing PAP and improving right heart function,can reduce pulmonary shunt,improve oxygenation,and enhance security in peri-operation anesthesia of lung transplantation.
Objective To observe the effects of alprostadil pump infusion through pulmonary artery on the lung ventilation( OLV) of patients with pulmonary hypertension( PH) in pulmonary transplantation. Methods Fifty patients who underwent off-pump lung transplantation for pulmonary fibrosis( PF) and PH were randomized into the control group( group C,n = 25) and alprostadil group( group P,n = 25). After placement of floating catheter for the double lung ventilation( DLV),patients in the group P received alprostadil pump infusion through the pulmonary artery at the dose of 5 ng/( kg·min) until the opening of the pulmonary artery. The patients in the group C received pump infusion with the equal volume of saline,and the remaining treatment was the same as that of the group P. Hemodynamics and gas exchange data before pulmonary arterial pumping of prostaglandin E1( PGE1)( T1),and 10 min( T2),15 min( T3),30 min( T4),45 min( T5),and 60 min( T6) of OLV after pump injection were observed. Hemorheology( HR),including arterial pressure( MAP),Pa O2,Pa CO2,pulmonary artery pressure( PAP),cardiac output,pulmonary vascular resistance( PVR),systemic vascular resistance( SVR),intrapulmonary shunt,Paw airway pressure( Paw),and dynamic lung compliance( Cldyn) were recorded. Results In the group P,the Pa O2,PAP,Clydn,and PVR significantly decreased after 10 min ventilation( P < 0. 05),however,Pa CO2,Paw,and Qs/Qt significantly increased( all P < 0. 05). In group C,after 10 min ventilation,the Pa O2 and Clydn significantly decreased,while Pa CO2,Paw,and Qs/Qt significantly increased( all P< 0. 05). The PAP and PVR significantly decreased after 20 min ventilation( P < 0. 05). When we compared the two groups simultaneously,except for the higher Pa O2,the other indicators were lower in the group P than in the group C after20 min ventilation( all P < 0. 05). Conclusion The alprostadil pump infusion through pulmonary artery on patients with pulmonary fibrosis and hypertension in lung transplantation,on the basis of reducing PAP and improving right heart function,can reduce pulmonary shunt,improve oxygenation,and enhance security in peri-operation anesthesia of lung transplantation.
引文
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[11]Zamanian RT,Haddad F,Doyle RL,et al. Managementstrategies for patients with pulmonary hypertension in theintensive care unit[J]. Crit Care Med,2007,35(9):2037-2050.
[12]候彦深,姜莉莉,蒋晖,等.单肺通气时不同潮气量对呼吸功能的影响[J].临床麻醉学杂志,2012,28(5):143-145.
[2]Gupta V,Rawat A,Ahsan F. Feasibility study of aerosolized prostaglandin E1 microspheresasa noninvasive therapy for pulmonary arterial hypertension[J]. J Pharm Sci,2010,99(4):1774-1789.
[3]Bund M,Henzler D,Walz R,et al. Aerosolized and intravenous prostacyclin during one-lung ventilation. Hemodynamic and pulmonary effects[J]. Anaesthesist,2004,53(7):612-620.
[4]Plantier L,Skhiri N,Biondi G,et al. Impact of previous cardiovascular disease on the outcome of lung transplantation[J]. J Heart Lung Transplant,2010,29(11):1270-1276.
[5]胡春晓,陈静瑜,王志萍,等.肺移植麻醉330例临床分析[J/OL].实用器官移植电子杂志,2015,3(6):337-341.
[6]Christie JD,Edwards LB,Kucheryavaya AY,et al. The Registry of the International Society for Heart and Lung Transplantation:twenty-seventh official adult lung and heart-lung transplant report-2010[J]. J Heart Lung Transplant,2010,29(10):1104-1118.
[7] Afifi S,Shayan S,Al-Qamari A. Pulmonary hypertension and rightventricular function:interdependence in pathophysiology and management[J]. Int Anesthesiol Clin,2009,47(1):97-120.
[8]焦点,顾连兵,王丽君,等.单肺通气前通气侧肺前列腺素E1超声雾化对气体交换的影响[J].临床麻醉学杂志,2016,32(7):668-671.
[9]Al-Hiti H,Melenovskv V,Syrovatka P,et al. Sildenafil is more selective pulmonary vasodilator than prostaglandin E1 in patients with pulmonary hypertension due to heart failure[J]. Physiol Res,2011,60(2):303-308.
[10]寇党培,王准,边卫,等.前列腺素E1肺动脉途径给药对肺动脉高压患者的降压效果[J].中华麻醉学杂志,2013,33(1):85-87.
[11]Zamanian RT,Haddad F,Doyle RL,et al. Managementstrategies for patients with pulmonary hypertension in theintensive care unit[J]. Crit Care Med,2007,35(9):2037-2050.
[12]候彦深,姜莉莉,蒋晖,等.单肺通气时不同潮气量对呼吸功能的影响[J].临床麻醉学杂志,2012,28(5):143-145.