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|本期目录/Table of Contents|

不同的吸入氧浓度对小儿先天性心脏病围术期气体交换的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第3期
页码:
377-380
栏目:
临床研究
出版日期:
2012-06-25

文章信息/Info

Title:
Influence of different types of ventilation on gas exchange in children wih congenital heart disease children during general anesthesia and postoperation
作者:
鞠吉峰123刘亚莉2乔 彬3吴莉莉3蒋怡燕3师建国1裴建明2
(第四军医大学:1.病理学与病理生理学教研室,2.生理学教研室,陕西 西安 710032;3.济南军区总医院心血管病研究所,山东 济南 250022)
Author(s):
JU Ji-feng123 LIU Ya-li2 QIAO Bin3 WU Li-li3 JIANG Yi-yan3 SHI Jian-guo1 PEI Jian-ming2
(1.Department of Pathology and Pathophysiology, 2.Department of Physiology, Fourth Military Medical University, Xi’an 710032, Shaanxi, China; 3.Cardic Institute of Jinan Military General Hospital, Ji’nan 250022, Shandong, China)
关键词:
心脏病先天性肺不张气体交换麻醉肺分流
Keywords:
congenital heart disease atelectasis gas exchange anesthesia pulmonary shunt
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:纯氧常规用于麻醉前预先吸氧和麻醉诱导,但吸高浓度氧会发生肺不张,可在全麻期间损害肺气体交换,本研究以吸入氧浓度(fraction of inspiration oxygen,FiO2)为纯氧(1 L/L)通气为对照,观察气管插管后FiO2为0.5 L/L混合空气通气对气体交换的影响。方法: 先天性心脏病(非紫绀型)手术患者102名,年龄1月~13岁,均以1 L/L O2在麻醉前预先吸氧3 min和(麻醉诱导时)面罩通气2 min,接下来气管插管。这些患者随机分为2组:混合通气组(51例,行FiO2为0.5 L/L O2通气),纯氧通气组(51例,行1 L/L O2通气)。分别于预先吸氧前和气管插管后30 min、入ICU、拔管后30 min以及术后前3 d做动脉血气分析,并计算动脉血氧分压(PaO2)/FiO2比值。结果: PaO2术后在入ICU(0.6 L/L FiO2)、拔管后30 min(1.5 L/min)面罩吸氧两个时间点,动脉血氧PaO2在混合通气组明显高于纯氧通气组,PaO2/FiO2值在插管后30 min、入ICU(0.6 L/L FiO2)、拔管后30 min(1.5 L/min)面罩吸氧等时间点混合通气组明显高于纯氧通气组(P<0.05),且混合通气组的ICU机械通气时间、住留时间及住院时间均明显缩短。结论: 先天性心脏病(非紫绀型)手术患儿全麻时,混合通气较纯氧通气能够显著的改善肺的气体交换功能和预后。
Abstract:
AIM:To evaluate the effect of ventilation with 0.5 L/L FiO2 in air or 1 L/L O2 following intubation on gas exchange. METHODS: One hundred and two patients (aged 1 month to 13 years) undergoing surgical cardiac intervention with congenital heart disease (CHD) (non-cyanosis) were given 1 L/L O2 for preoxygenation (3 min) and ventilation by mask (2 min). Following intubation, patients were randomly divided into two groups (51 patients in each group) and ventilated with either 0.5 L/L FiO2 in air or 1 L/L O2. Arterial blood gases were obtained for analysis before preoxygenation, 30 min following intubation, on entering the ICU, 30 min after extubation and 3 days postoperation. Subsequently, PaO2/FiO2 ratios were calculated. RESULTS: PaO2 values on entering ICU and 30 min after extubation were significantly improved in the group receiving 0.5 L/L FiO2 group than those in the group receiving 1 L/L O2. PaO2/FiO2 ratio in the 0.5 L/L FiO2 group was significantly improved at the following time points: 30 min after intubation, upon entering the ICU and 30 min after extubation. Mechanical ventilation time, time in ICU and length of hospitalization in 0.5 L/L FiO2 group were significantly shortened compared with those in the group receiving 1 L/L O2. CONCLUSION: During general anesthesia in children with CHD (non-cyanosis), ventilation of lungs with 0.5 L/L FiO2 is superior for improving gas exchange than ventilation of lungs with 1 L/L O2.

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备注/Memo

备注/Memo:
收稿日期:2011-12-15.通讯作者:裴建明,教授,主要从事心血管生理学研究Email:jmpei8@fmmu.edu.cn 共同通讯作者:师建国,教授,主要从事病理学研究 Email:shijg2000@yahoo.com.cn 作者简介:鞠吉峰,副主任医师,硕士生 Email:jujifeng777@sina.com
更新日期/Last Update: 2012-05-02