Jonmarker C, Larsson A, Werner O
Anesthesiology. 1986 Sep;65(3):259-65.
To examine the effects of cardiac surgery and cardiopulmonary bypass (CPB) on the lung, functional residual capacity (FRC) and lung-thorax compliance were measured at four stages during open heart surgery in 15 children. The patients were anesthetized with fentanyl/droperidol and N2O/O2, paralyzed, and ventilated with volume-controlled mechanical ventilation at 20-30 breaths/min. FRC was measured by tracer gas washout. Static lung-thorax compliance (CLT) was calculated as tidal volume divided by the airway pressure difference between the end of the postinspiratory pause and the end of the expiration, and also from the increase in FRC caused by adding 5 cmH2O of PEEP (CLT[FRC]). Before skin incision, both FRC and compliance were closely correlated with weight and length. During this stage, FRC was 21 +/- 5 ml/kg, CLT 0.90 +/- 0.21, and CLT(FRC) 1.28 +/- 0.35 ml X cmH2O-1 X kg-1 X PEEP 5 increased FRC by 34 +/- 9%. In patients with intact pleural cavities throughout the operation (n = 10), FRC increased by 4 +/- 2 ml/kg when the sternum was retracted (P less than 0.01). During CPB, FRC decreased by 4 +/- 3 ml/kg (P less than 0.01), and FRC at the end of surgery was 5 +/- 4 ml/kg less than before skin incision (P less than 0.01). In these ten children, there was a 13% and 6% decrease in mean CLT and CLT(FRC), respectively, during the operation (P less than 0.05) and mean CLT(FRC) was at least 40% greater than CLT during all four stages (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
为研究心脏手术及体外循环（CPB）对肺的影响，对15名儿童在心脏直视手术的四个阶段测量了功能残气量（FRC）和肺胸顺应性。患者用芬太尼/氟哌利多及N₂O/O₂麻醉，肌肉松弛，并以容量控制机械通气，呼吸频率为20 - 30次/分钟。FRC通过示踪气体洗脱法测量。静态肺胸顺应性（CLT）计算为潮气量除以吸气末暂停结束与呼气结束之间的气道压差，也可根据加5 cmH₂O呼气末正压（PEEP）导致的FRC增加来计算（CLT[FRC]）。皮肤切开前，FRC和顺应性均与体重和身长密切相关。在此阶段，FRC为21±5 ml/kg，CLT为0.90±0.21，CLT(FRC)为1.28±0.35 ml·cmH₂O⁻¹·kg⁻¹，PEEP 5使FRC增加34±9%。在整个手术过程中胸膜腔完整的患者（n = 10）中，胸骨牵开时FRC增加4±2 ml/kg（P < 0.01）。在CPB期间，FRC下降4±3 ml/kg（P < 0.01），手术结束时FRC比皮肤切开前减少5±4 ml/kg（P < 0.01）。在这10名儿童中，手术期间平均CLT和CLT(FRC)分别下降13%和6%（P < 0.05），且在所有四个阶段平均CLT(FRC)均比CLT至少大40%（P < 0.01）。（摘要截短于250字）
