中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

体外循环急性肺损伤与肺保护策略的研究进展

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急性肺损伤是体外循环(cardiopulmonary bypass,CPB)术后的常见并发症。导致 CPB 术后急性肺损伤的危险因素主要为缺血/再灌注损伤和全身炎症反应综合征(systemic inflammatory response syndrome,SIRS),同时肺不张、术中输血、高龄、术前心功能不全、急诊手术、长时间转机等因素均是导致 CPB 术后急性肺损伤的危险因素。目前,预防 CPB 术后急性肺损伤的措施主要包括机械干预、外科技术干预、麻醉管理干预等,其主要目的是为了减轻 CPB 所致接触激活反应、SIRS、白细胞蓄积、血液稀释等。本文对 CPB 术后急性肺损伤的病因、危险因素及相关预防措施加以综述。

Acute lung injury is a kind of common complication after cardiopulmonary bypass. Acute lung injury is attributed to the ischemia-reperfusion injury and systemic inflammatory response syndrome. Several factors common in cardiac surgery with cardiopulmonary bypass may worsen the risk for acuter lung injury including atelectasis, transfusion requirement, older age, heart failure, emergency surgery and prolonged duration of bypass. Targets for prevention of acute lung injury include mechanical, surgical and anesthetic interventions that aim to reduce the contact activation, systemic inflammatory response, leukocyte sequestration and hemodilution associated with cardiopulmonary bypass. We aim to review the etiology, risk factors and lung protective strategies for acute lung injury after cardiopulmonary bypass.

关键词: 体外循环; 全身炎症反应综合征; 缺血/再灌注损伤; 急性肺损伤; 肺保护

Key words: Cardiopulmonary bypass; systemic inflammatory response syndrome; ischemia-reperfusion injury; acute lung injury; lung protection

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