Ugurlucan Murat, Basaran Murat, Erdim Filiz, Selimoglu Ozer, Caglar Ilker Murat, Zencirci Ertugrul, Filizcan Ugur, Ogus Noyan Temucin, Yildiz Yahya, Tireli Emin, Isik Omer, Dayioglu Enver
Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
Cardiovascular Surgery Clinic, Istanbul Cerrahi Hospital, Istanbul, Turkey.
Heart Surg Forum. 2014 Feb;17(1):E1-6. doi: 10.1532/HSF98.2013236.
Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population.
Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups.
Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ.
There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.
体外循环在一定程度上会使肺功能恶化。慢性阻塞性肺疾病（COPD）患者在心脏直视手术后的围手术期死亡率和发病率风险会增加。在本研究中，我们在这一特定患者群体中比较了两种不同的机械通气模式，即压力控制通气（PCV）和容量控制通气（VCV）。
40例重度COPD患者被分为两组中的一组，并在术后接受PCV或VCV治疗。比较两组之间的动脉血气、呼吸参数以及重症监护病房停留时间和住院时间。
VCV组的最大气道压力较高。VCV组的肺顺应性较低，而采用PCV模式通气的组分钟通气量显著较低。与VCV组及术前结果相比，PCV组的呼吸指数升高。PCV模式下机械通气时间显著缩短；然而，重症监护病房停留时间和住院时间并无差异。
对于接受心脏直视手术的COPD患者，没有一种被广泛接受和确立的通气模式。我们有限的经验表明PCV模式有良好的结果；然而，仍需进一步研究。
