Ge Huiqing, Lin Ling, Xu Ying, Xu Peifeng, Duan Kailiang, Pan Qing, Ying Kejing
Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Physiol. 2021 Jun 3;12:684927. doi: 10.3389/fphys.2021.684927. eCollection 2021.
Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients.
To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients.
A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared.
A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min⋅m; < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m; < 0.05) were also observed in the APRV group after 4 h as well as within the first day ( < 0.05). Compared to the PCV group, the PaO2/FiO was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, < 0.05) and within the first three days ( < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group ( < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly ( = 0.248 and 0.424, respectively).
Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.
术后肺部并发症和心血管并发症是心脏手术患者发病、死亡及资源利用的主要原因。
探讨气道压力释放通气（APRV）对心脏手术后患者呼吸和血流动力学的影响。
进行了一项单中心随机对照试验。前瞻性筛查了总共138例接受体外循环的患者。最终39例患者符合纳入标准并被随机分为两组：19例患者采用压力控制通气（PCV）管理，20例患者采用APRV管理。记录并比较4小时后的呼吸力学、第一天内的血流动力学以及前三天内的胸部X线片评分（CRS）和血气。
APRV组在4小时后以及第一天内还观察到较高的心指数（3.1±0.7对2.8±0.8L·min·m；P<0.05）和每搏量指数（35.4±9.2对33.1±9.7ml/m；P<0.05）（P<0.05）。与PCV组相比，APRV组患者在4小时后（340±97对301±82，P<0.05）以及前三天内（P<0.05）的PaO2/FiO显著更高。CRS显示APRV组的总体肺损伤较少（P<0.001）。机械通气时间和ICU住院时间无显著差异（分别为P = 0.248和0.424）。
与PCV相比，APRV可能与心脏手术后患者的心输出量增加、氧合改善及肺损伤减少有关。
