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|本期目录/Table of Contents|

紫绀型先天性心脏病术后急性肺损伤的治疗

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第6期
页码:
753-756
栏目:
临床研究
出版日期:
2012-12-25

文章信息/Info

Title:
Treatment of acute lung injury after surgical treatment of cyanotic congenital heart disease
作者:
浮志坤; 董自超; 姚 伟; 陈小三; 赵 君; 谷小卫; 杜 虹
(解放军第91中心医院心脏外科，河南 焦作 454003)
Author(s):
FU Zhi-kun;  DONG Zi-chao;  YAO Wei;  CHEN Xiao-san;  ZHAO Jun;  GU Xiao-wei;  DU Hong
(Department of Cardiac Surgery, PLA 91st Central Hospital, Jiaozuo 454003, Henan, China)
关键词:
心脏病; 先天性; 紫绀型; 急性肺损伤体外循环
Keywords:
cyanotic congenital heart disease;  acute lung injury;  cardiopulmonary bypass
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:分析紫绀型先天性心脏病术后的急性肺损伤（ALI）的原因，总结治疗体会。方法： 总结我院2007年3月~2011年10月治疗C-CHD 79例，发生ALI 12例。记录12例ALI患儿术前经皮氧饱和度（SpO2）、血细胞比容（HCT）、McGoon比值、Nakata指数和手术、体外循环(CPB)时间,以及ALI发生后的各项治疗措施。结果： 术后12例发生ALI，发生率为15%。年龄8～63（19±8）个月，体质量8～25（15±4）kg。手术均在静吸复合麻醉CPB下进行，术后予以改良超滤，CPB时间（117±12） min，主动脉阻断时间（81±13） min。11例应用腹膜透析术（PD），5例予以吸入一氧化氮（NO），1例予以肺表面活性物质（PS）替代治疗，效果良好。最终死亡4例，死亡率33.3%。结论： C-CHD术后ALI发生率高，治疗困难，早期合理的辅助机械通气、维持内环境的稳定、积极的配合PS替代及NO吸入治疗，积极的改善肺通气及氧合，以改善肺间质水肿、阻断机体炎性反应的恶性循环，利于患儿早期的恢复。
Abstract:
AIM:To analyze the causes of acute lung injury (ALI) after surgical treatment of cyanotic congenital heart disease (C-CHD) and to summarize the postoperative therapeutic experience. METHODS: Included in the study were 79 patients with C-CHD who underwent surgical treatment in our hospital from March 2007 to October 2011; 12 patients developed ALI postoperatively. Transcutaneous oxygen saturation (SpO2), hematocrit (HCT), McGoon ratio, Nakata index and CPB data and therapeutic data of the 12 patients with ALI were collected. RESULTS: There were 12 cases complicated by ALI with a morbidity of 15%. The mean age of the 12 patients was (19±8) months (8-63 months) and the mean body weight was (15±4) kg (8-25 kg). Surgical procedures of the 12 cases were all performed under intravenous-inhalation combined anesthesia and cardiopulmonary bypass (CPB) and modified ultrafiltration was used postoperatively. Total CPB time and aortic clamp time were (117±12) min and (81±13) min, respectively. Peritoneal dialysis (PD) was performed in 11 cases. Five patients were given inhaled nitric oxide (NO) and one patient was given pulmonary surfactant (PS). Four patients died and the total mortality rate was 33.3%. CONCLUSION: Incidence of ALI after surgical treatment of C-CHD is high. Proper mechanical ventilation and appropriate fluid balance will improve pulmonary function as well as early recovery of the patients. A positive PS replacement or NO inhalation therapy may be useful.

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备注/Memo

备注/Memo:
收稿日期: 2012-05-26.作者简介：浮志坤，主治医师 Email:fuzhikun@126.com
更新日期/Last Update: 2012-12-30