Minkovich Leonid, Djaiani George, Katznelson Rita, Day Fergal, Fedorko Ludwik, Tan Jens, Carroll Jo, Cheng Davy, Karski Jacek
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Cardiothorac Vasc Anesth. 2007 Jun;21(3):375-8. doi: 10.1053/j.jvca.2006.01.003. Epub 2006 Apr 21.
Pulmonary atelectasis and hypoxemia remain considerable problems after cardiac surgery. The objective of this study was to determine the efficacy of consecutive vital capacity maneuvers (C-VCMs) to improve oxygenation in patients after cardiac surgery.
Randomized, controlled clinical trial.
Tertiary referral teaching center.
Ninety-five patients requiring elective cardiac surgery with cardiopulmonary bypass (CPB).
Patients were randomly allocated to either C-VCM or control groups. In the C-VCM group, lung inflation at pressure of 35 cmH(2)O was sustained for 15 seconds before separation from CPB and at 30 cmH(2)O for 5 seconds after admission to the intensive care unit (ICU).
The primary outcome was the ratio of arterial oxygen tension to inspired oxygen fraction measured at the following predetermined time intervals: after induction of anesthesia, 15 minutes after separation from CPB, after admission to the ICU, after 3 hours of positive-pressure ventilation, after extubation, and before ICU discharge. C-VCM resulted in better arterial oxygenation extending from the immediate postoperative period to approximately 24 hours after surgery at the time of ICU discharge. There were no significant adverse events related to C-VCM application.
C-VCM is an effective method to reduce hypoxemia associated with the formation of atelectasis after cardiac surgery with CPB.
心脏手术后肺不张和低氧血症仍然是相当严重的问题。本研究的目的是确定连续肺活量动作（C-VCMs）对改善心脏手术后患者氧合的疗效。
随机对照临床试验。
三级转诊教学中心。
95例需要接受体外循环（CPB）择期心脏手术的患者。
患者被随机分配至C-VCM组或对照组。在C-VCM组中，在脱离CPB前以35 cmH₂O的压力持续肺膨胀15秒，并在入住重症监护病房（ICU）后以30 cmH₂O的压力持续5秒。
主要结局指标是在以下预定时间间隔测量的动脉血氧分压与吸入氧分数之比：麻醉诱导后、脱离CPB后15分钟、入住ICU后、正压通气3小时后、拔管后以及ICU出院前。C-VCM可改善从术后即刻到ICU出院时术后约24小时的动脉氧合。应用C-VCM未出现明显不良事件。
C-VCM是一种有效降低CPB心脏手术后与肺不张形成相关的低氧血症的方法。
