CHANGES IN LUNG-FUNCTION AND PULMONARY CAPILLARY-PERMEABILITY AFTER CARDIOPULMONARY BYPASS

被引:86
作者
MACNAUGHTON, PD [1 ]
BRAUDE, S [1 ]
HUNTER, DN [1 ]
DENISON, DM [1 ]
EVANS, TW [1 ]
机构
[1] ROYAL BROMPTON NATL HEART & LUNG HOSP,NATL HEART & LUNG INST,LONDON SW3 6HP,ENGLAND
关键词
CARDIOPULMONARY BYPASS; ADULT RESPIRATORY DISTRESS SYNDROME; CAPILLARY PERMEABILITY; RESPIRATORY FUNCTION TESTS; PULMONARY DIFFUSING CAPACITY; LUNG VOLUME MEASUREMENT; CARDIAC SURGERY; HEART; LUNG;
D O I
10.1097/00003246-199209000-00016
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To assess the possibility that changes in lung function following cardiopulmonary bypass are associated with increased pulmonary capillary permeability. Design: A prospective, descriptive study. Setting: Adult cardiothoracic ICU in a post-graduate teaching hospital. Patients: Ten sequential patients undergoing cardiac surgery requiring cardiopulmonary bypass. Measurements: Arterial blood gas tensions, helium dilution end-expiratory lung volume, and carbon monoxide transfer were measured by a rebreathing technique preoperatively and 2 hrs postoperatively. Lung extravascular protein accumulation index was measured by a double-isotope technique 2 hrs postoperatively and in a group of normal controls. Results: Mean +/- SEM alveolar-arterial PO2 gradient increased from 77 +/- 14 torr (10.3 +/- 1.8 kPa) to 138 +/- 24 torr (18.5 +/- 3.2 kPa) (p < .01). Functional residual capacity decreased by 20.2 +/- 5.6% (p < .01). Carbon monoxide transfer decreased by 26.7 +/- 5.3% (p <.01) for the lung as a whole and by 17.9 +/- 3.2% (p <.01) per liter of accessible gas volume. Protein accumulation index ranged from 0.03 to 3.2 x 10(-3) (median 0.6) postoperatively (median for normal subjects 0.4; p <. 05), although only one patient had a value indicative of clinically important endothelial injury. Conclusions: Cardiac surgery involving cardiopulmonary bypass results in a deterioration in lung function characterized by a loss of lung volume, a reduction in carbon monoxide transfer, and an increase in the alveolar-arterial PO2 gradient. These changes do not appear to be mediated by an increase in pulmonary endothelial permeability.
引用
收藏
页码:1289 / 1294
页数:6
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