脑钠肽与血乳酸清除率在A型主动脉夹层术后呼吸功能不全的临床研宄【摘要】目的：观察脑钠肱水平及血乳酸清除率在A型主动脉夹层术后发生呼吸功能不全时的动态变化，以评估肺损伤程度，指导撤机的作用。方法：选取2010年10月-2015年10月本院行A型主动脉夹层术后出现呼吸功能不全的患者42例，根据患者氧合指数将其分为急性肺损伤组（ALI组）（氧合指数：200mmHg^Pa02/Fi02^300mmHg）及ARDS组（Pa02/Fi02^200mmHg）,依撤机结果分为撤机成功组（成功撤机拔管且48h无需复插或通气支持），撤机失败组（脱机拔管后48h内再次复插或需通气支持）。观察血乳酸、血气分析及脑钠肽转入时、6、24、48h、3d直到转出时动态变化情况。结果：所有A型主动脉夹层术后呼吸功能不全患者均出现血乳酸增高，以转入时明显，之后逐渐下降，脑钠肽水平逐渐升高，ALI组3d达高峰，5d明显回落，氧合指数明显改善，ARDS组5d达高峰，7d明显回落，氧合指数明显改善。撤机成功组较撤机失败组脑钠肽水平明显低，血乳酸清除率高，组间比较差异均有统计学意义（P【关键词】脑钠肽；血乳酸清除率；A型主动脉夹层；呼吸功能不全；撤机ClinicalStudyofBrainNatriureticPeptideandBloodLactateClearanceRateinTypeAAorticDissectionofPostoperativeRespiratoryInsufficiency/OUYANGXiao-xian,LIUYi-lin,LILi,etal.//MedicalInnovationofChina，2016,13(17):030-033【Abstract】Objective:Toobservedynamicchangesofbrainnatriureticpeptide(BNP)levelsandbloodlactateclearancerateforpostoperativerespiratoryinsufficiencyoftypeAaorticdissectionsurgery，inordertoassesstheextentoflunginjury，guidetheroleofweaning.Method:Atotalof42patientswithpostoperativerespiratoryinsufficiencyoftypeAaorticdissectionsurgeryinourhospitalwereselectedfromOctober2010toOctober2015.Accordingtopatientswithoxygenindextotheacutelunginjurygroup(ALI)(oxygenationindex：200mmHg^PaO2/FiO2<300mmHg)andARDSgroup(PaO2/FiO2^200mmHg)，accordingtoventilatorweaningresultsfortheweaningsuccessgroup(successfulweaningandextubationand48hwithoutcomplexinventilationorsupport)theweaningfailuregroup(48hafterweaningneedtobeventilatedagain).Bloodlacticacid，bloodgasanalysisandbrainnatriureticpeptidewereobservedattransferred，6，24，48h，3duntilturnout.Result：AllpatientswithpostoperativerespiratoryinsufficiencyoftypeAaorticdissectionsurgeryhadhigherbloodlacticacidinthepatientswithrespiratoryinsufficiencyafteroperation,intotheobvious，thengraduallydecreased,BNPlevelsincreasedgradually，theALIgroupreachedthepeakat3dand5ddroppedsignificantly，oxygenationindeximprovedsignificantlyintheARDSgroupreachedthepeakatthe5d，7ddroppedsignificantly，oxygenationindeximprovedsignificantly.Theweaningsuccessfulgroupwascomparedwiththeweaningfailuregroup，BNPlevelwassignificantlylower，bloodlactateclearanceratewashigherandthedifferencesbetweenthetwogroupshadstatisticalsignificance(P【Keywords】Brainnatriureticpeptide；Bloodlactateclearancerate；TypeAaorticdissection；Respiratoryinsufficiency；VentilatorweaningFirst-author’saddress：YueBeiPeople’sHospital,Shaoguan512026，Chinadoi：10.3969/j.issn.1674-4985.2016.17.008急性呼吸功能不全（ARD）是心血管手术后常见的并发症之一［1］，心血管手术中主动脉手术较复杂，时间长，尤其A型主动脉夹层常需要在深低温停循环（DHCA）下完成主动脉弓部替换，DHCA引起的肺组织低温和灌注减少可能会增加急性肺损伤的发生率。另外，A型主动脉夹中急性病变占多数［2］。A型主动脉夹层术后患者容易出现呼吸功能不全的现象，本文就脑钠肽（BNP）与血乳酸清除率和A型主动脉夹层术后呼吸功能不全程度之间的联系进行分析，以评估呼吸功能不全严重程度及指导术后撤机的临床意义。1资料与方法1.1一般资料选取2010年8月-...