Figueiredo Luciana Castilho de, Araújo Sebastião, Abdala Rosângela Cristina S, Abdala Abrão, Guedes Cristina Aparecida Veloso
Intensive Care Unit, Hospital de Clínicas, Campinas State University.
Rev Bras Cir Cardiovasc. 2008 Apr-Jun;23(2):209-15. doi: 10.1590/s0102-76382008000200010.
To compare postoperative (PO) pulmonary gas exchange indexes in patients submitted to myocardial revascularization (MR) with or without the application of continuous positive airway pressure (CPAP) during cardiopulmonary bypass (CPB).
Thirty adult patients submitted to MR with CPB between March and September 2005 were randomly allocated to two groups: CPAP (n=15), patients that received CPAP at 10 cm H2O during CPB, and control (n=15), patients that didn't receive CPAP. PaO(2)/FiO2 and P(A-a)O2 were analyzed at four moments: Pre (just before CPB, with FiO2=1.0 ); Post (30 min post-CPB, with FiO2=1.0); immediate PO period (12h post-surgery, with FiO2=0.4 by using a Venturi(R) facial mask) and first PO day (24h post-surgery, with FiO2=0.5 by a facial mask).
PaO2/FiO2 and P(A-a)O2 tend to get significantly worst as time elapsed during the postoperative period in both groups, but no differences were observed between them at any moment. When PaO2/FiO2 was subdivided into three categories, a greater prevalence of patients with values between 200 mmHg and 300 mmHg were observed in CPAP group only at moment Post (30 min post-CPB; p = 0.02).
CPAP at 10 cm H2O administered during CPB, although had lightly improved PaO2/FiO2 at 30 minutes post-CPB, had no significant sustained effect on postoperative pulmonary gas exchange. We concluded that in patients submitted to MR, application of 10 cmH2O CPAP does not improve postoperative pulmonary gas exchange.
比较在体外循环（CPB）期间接受或未接受持续气道正压通气（CPAP）的心肌血运重建（MR）患者的术后（PO）肺气体交换指标。
将2005年3月至9月期间接受CPB下MR的30例成年患者随机分为两组：CPAP组（n = 15），即在CPB期间接受10 cm H₂O CPAP的患者；对照组（n = 15），即未接受CPAP的患者。在四个时间点分析动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）和肺泡 - 动脉血氧分压差（P(A - a)O₂）：术前（CPB前即刻，FiO₂ = 1.0）；术后（CPB后30分钟，FiO₂ = 1.0）；术后即刻（术后12小时，使用文丘里面罩，FiO₂ = 0.4）和术后第一天（术后24小时，使用面罩，FiO₂ = 0.5）。
两组患者术后随着时间推移，PaO₂/FiO₂和P(A - a)O₂均有明显恶化趋势，但在任何时间点两组之间均未观察到差异。当将PaO₂/FiO₂分为三类时，仅在术后（CPB后30分钟）这一时刻，CPAP组中PaO₂/FiO₂值在200 mmHg至300 mmHg之间的患者比例更高（p = 0.02）。
CPB期间给予10 cm H₂O的CPAP，虽然在CPB后30分钟时轻度改善了PaO₂/FiO₂，但对术后肺气体交换没有显著的持续影响。我们得出结论，在接受MR的患者中，应用10 cmH₂O的CPAP并不能改善术后肺气体交换。
