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|本期目录/Table of Contents|

先天性心脏病患儿围术期呼吸功能的保护(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2006年第6期
页码:
685-687
栏目:
临床研究
出版日期:
2006-12-25

文章信息/Info

Title:
Early perioperative respinatory function protection in children with congenital heart diseases
作者:
崔勤; 俞世强; 赵荣;  郑霄; 朱海龙; 张金州; 金振晓; 张胜利; 赵建斌
第四军医大学西京医院心血管外科中心，陕西 西安710033
Author(s):
CUI Qin;  YU Shi-qiang;  ZHAO Rong;  ZENG Xiao;  ZHU Hai-long;  ZHANG Jin-zhou;  JIN Zhen-Xiao;  ZHANG Sheng-li;  ZHAO Jian-bin
Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi′an,Shaanxi 710033, China
关键词:
心脏病; 先天性; 围术期; 呼吸功能
Keywords:
heart disease; congenital;  perioperative;  respiratory function
分类号:
R322.3; R654.1
DOI:
-
文献标识码:
A
摘要:
目的 探讨婴幼儿体外循环手术围术期影响呼吸功能的因素及呼吸功能保护策略。方法 本文以婴幼儿呼吸道解剖学与病理生理学特点为基础，对不同先天性心脏病及麻醉与体外循环对该类患儿呼吸功能的影响进行全面系统分析，提出心脏手术后呼吸管理策略与方法，如术中的肺保护措施、呼氧末正压（PEEP）的应用、适当过度通气、大心脏患儿采用俯卧位通气、重度低氧血症患儿及时应用外源性肺表面活性物质、肺泡复张手法的应用、气管镜吸痰等策略及方法。结果 通过上述策略与方法的实施，我科婴幼儿术后呼吸道管理与早期相比，有了显著进步，机械通气时间由以往的（19.2±6.4）h,减少到（11.9±2.5）h（P<0.01）,ICU时间由（7.2±3.9）d,下降到（4.1±2.6）d（P<0.01）,手术死亡率由5.6％(44/790)下降到3.9 ％(23/584，P<0.05）。 结论 围术期有多种因素影响先天性心脏病患儿呼吸功能，早期就开始注意肺保护功能，将会收到明显效果。
Abstract:
AIM To explore the factors that influence respiratory function and strategies for protecting respiratory function during perioperative period in infants after cardiac pulmonary bypass (CPB). METHODS Based on the anatomy and pathophysiology of infant respiratory tract, we comprehensively analyzed the effects of different kinds of congenital heart diseases, anesthetics and CPB on infant's respiratory function and proposed some postoperation respiratory management strategies, which included pulmonary protection during surgery, administration of positive endexpiratory pressure (PEEP), proper overventilation, prone position ventilation for large heart infants, timely administration of extrinsic pulmonary surfactant in infants with high degree hypoxia, pulmonary recruitment maneuver, and draining phlegm by tracheascope. RESULTS The above strategies and methods greatly improved the pulmonary management in infants in our unit. Mechanical ventilation support duration was decreased from (19.2±6.4)h to (11.9±2.5)h（P<0.01）, ICU stay was decreased from (7.2±3.9)d to (4.1±2.6)d（P<0.01） and operative mortality rate was decreased from 5.6％ (44/790) to 3.9％ (23/584,P<0.05）. CONCLUSION There are many factors that affect infants’ pulmonary function during perioperative period. Early pulmonary function protection will produce better outcome.

参考文献/References

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［6］ 杨秀玲，郑霄，崔勤，等. 心脏术后实施俯卧位通气的护理观察［J］. 解放军护理杂志, 2003,20(3)：67-68.

［7］ Lobacheva GV, Khar′kin AV, Aksenov AV,et al. Use of the exogenous surfactant in combined therapy for acute respiratory failure in children after cardiosurgical interventions［J］. Anesteziol Reanimatol, 2005, (3):35-38.

［8］ Tusman G,Bohm SH,Tempra A，et al. Elsio Turchetto, Paul G. H. Mulder, M.S, Burkhard Lachmann. Effects of Recruitment Maneuver on Atelectasis in Anesthetized Children［J］. Anesthesiology,2003,98(1): 14-22.

备注/Memo

备注/Memo:
收稿日期：2005-11-08.作者简介：崔勤，副主任医师 Tel：（029）84775313 Email：cuiqin@fmmu.edu.cn
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