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目的探讨跨肺压监测在急性主动脉夹层Stanford A型手术后患者中的应用。方法选择2015年1-10月收治我院重症医学科经CT确诊“急性主动脉夹层Stanford A型”在急诊全麻深低温体外循环下行“Cabrol加升主动脉及全弓替换加降主动脉支架象鼻手术患者19例,随机分为两组,观察组9例,对照组10例。两组患者入室后,每日均给予肺复张治疗,观察组患者通过食道压监测设定呼气末正压(PEEP)值,维持跨肺压为正值;对照组患者则通过PEEP递增法设定PEEP值,观察两组患者0 h、24 h、48 h、72 h肺顺应性、氧合指数、PEEP值及总机械通气时间、住ICU时间、住院时间。结果两组患者0 h及入室时肺顺应性、氧合指数、PEEP值比较差异无统计学意义(P>0.05),入室后观察组患者通过食道压监测维持呼气末跨肺压为正值后24 h、48 h、72 h监测肺顺应性、氧合指数、PEEP值高于对照组,两组比较差异有统计学意义(P<0.05),观察组总机械通气时间少于对照组(P<0.05),两组患者住ICU时间、住院时间比较差异无统计学意义(P>0.05)。结论通过食道压监测设定PEEP值在急性主动脉夹层Stanford A型手术后患者跨肺压维持方面具有指导意义,且在维持跨肺压的过程中更需要护士精心护理,规范护理操作,连续监测、自动调整气囊压力,保持呼吸机管路的密闭性。
Objective To investigate the application of trans-pulmonary pressure monitoring in patients with Stanford type A after acute aortic dissection. Methods From January to October 2015, our hospital was admitted to the Department of Critical Care Medicine by CT confirmed ”Acute dissection Stanford A type“ in emergency general anesthesia with hypothermia cardiopulmonary bypass ”Cabrol plus aortic replacement and whole bow replacement 19 cases of aortic stent elephant nasal surgery were randomly divided into two groups, the observation group 9 cases and the control group 10 cases.After the two groups of patients entered the room, were given pulmonary re-treatment, the observation group patients through esophageal pressure monitoring settings Positive PEEP values were maintained for positive transpiration; PEEP values were set by PEEP increment in control group. Lung compliance at 0, 24, 48, 72 h was observed in both groups, Oxygenation index, PEEP value, total mechanical ventilation time, ICU stay time and hospital stay.Results There was no significant difference in lung compliance, oxygenation index and PEEP between the two groups at 0 h and at admission (P> 0.05) After admission, the observational lung compliance, oxygenation index and PEEP value of patients in observation group at 24 h, 48 h and 72 h after esophageal pressure monitoring were maintained at positive end-expiratory pressure were higher than those in control group (P <0.05). The total mechanical ventilation time in the observation group was less than that in the control group (P <0.05). The ICU time (P> 0.05) .Conclusion It is instructive to set the PEEP value by esophageal pressure monitoring in patients with Stanford type A surgery after acute aortic dissection and to maintain the trans-pulmonary pressure During the process, the nurses should be well-nursed and standardized nursing operations. Continuous monitoring should be performed to automatically adjust the pressure of the balloon to maintain the tightness of the ventilator’s pipeline.