摘要
目的研究先天性心脏病婴儿心脏直视手术围体外循环(CPB)期肺功能的动态变化规律,指导临床预防和减轻CPB急性肺损伤。方法2007年3-9月在本院手术治疗的室间隔缺损(VSD)婴儿68例。术前无肺炎及其他肺部疾病。CPB时间(66.04±18.68)min,主动脉阻断时间(38.46±13.76)min,术后应用定压同步间歇指令通气(SIMV)模式通气,机械通气时间(11.44±9.63)h。分别于CPB前,CPB 2、6、12、24、48h测定动脉血氧分压[pa(O2)]、二氧化碳分压[pa(CO2)]及吸氧体积分数(FiO2)。计算氧合指数(OI)、肺泡-动脉血氧分压差(A-aDO2)、动脉/肺泡氧分压比值[pa(O2)/pA(O2)]、呼吸指数(RI)。结果OI:CPB 2 h(393.20±189.03)、6h(385.35±175.09)较CPB前(517.17±86.29)均显著降低(t=4.955,5.569 Pa<0.01),CPB 12 h(481.58±239.72)、24h(488.94±244.26)、48h(476.02±227.85)与CPB前比较均无统计学差异(t=1.152,0.899,1.393 Pa>0.05)。pa(O2)/pA(O2):CPB 2 h(0.54±0.26)、6h(0.69±0.32)较CPB前(0.79±0.13)均显著降低(t=2.837 P<0.01,t=2.387 P<0.05),CPB 12h(0.74±0.31)、24h(0.82±0.42)、48h(0.76±0.39)与CPB前比较均无统计学差异(t=1.227,0.563,0.602 Pa>0.05)。(A-aDO2):CPB 2 h(156.10±148.48)、6h(141.46±133.52)与CPB前(125.53±70.85)比较均无统计学差异(t=1.532,0.869 Pa>0.05),CPB 12h(96.33±76.09)、24h(98.63±75.73)、48h(100.77±69.48)较CPB前(125.53±70.85)均显著降低(t=2.316,2.139,2.058 Pa<0.05),且差异有扩大趋势。RI:CPB后2h(0.90±0.73)、6h(0.86±0.69)均较CPB前(0.41±0.20)显著升高(t=5.338,5.165 Pa<0.01),CPB后12h(0.49±0.41)、24h(0.51±0.46)、48h(0.53±0.49)与CPB前比较均无统计学差异(t=1.446,1.644,1.870 Pa>0.05)。结论CPB对婴儿肺功能有明显损伤,且在术后早期较为严重,随着时间的延续肺功能逐渐恢复。加强CPB后早期的呼吸循环管理是减轻肺损伤、促进肺功能恢复的重点。
Objective To study the dynamic changes of pulmonary function peri - cardiopulmonary bypass（CPB） for preyenting and reducing acute lung injury caused by CPB in infants with congenital heart disease. Methods Sixty - eight infants with ventricular septal defect （VSD） underwent corrective surgery which had 47 male and 21 famale from Mar. to Sep. 2007 in the hospital were detected, aged（5.1 ± 2.3 ） months,weight （6.4 ± 3.8 ） kg,the average time of CPB was （66.04 ± 18.68 ） minutes, and the aortic clamping time was （ 38.46 ± 13.76 ） minutes. There were no pneumonia and other pulmonary disease before operation. All cases were underwent mechanical ventilation in synchronized intermittent mandatory ventilation （SIMV） mode, duration of mechanical ventilation was （ 11.44 ± 9.63 ） hours, p, （ 02 ） ,p, （ CO2 ） and FiO2 were measured before CPB, and 2,6,12,24,48 h after CPB. Lung oxygenation indicators： oxygenation index （ OI ）, pulmonary alveolar oxygen partial pressure ratio [pa （ O2 ）/PA （ O2 ） ] , respiratory index （ RI ） and alveolar - arterial blood oxygen difference （ A - aDO2 ） were calculated. Results OI：2 h（393.20 ± 189.03）,6 h （385.35 ± 175.09） post -CPB were lower than that of pre- CPB（517.17 ± 86.29） （t=4.955,5.569 P,〈O. O1）,therewere no differences at 12 h（481.58±239.72）,24 h（488.94±244.26）,48 h（476.02±227.85） post-CPBcomparedwiththatofpre-CPB（t=1.152,0.899,1.393 P 〉O.05）.p,（O2）/pA（02）： 2 h（0.54±0.26）,6 h（0.69± 0.32） post-CPBwerelowerthanthatofpre-CPB（O.79±O. 13）（t=2.837 P〈0. 01,t=2.387 P〈0.05 ） , there were no significant differences at 12 h （0.74 ± O. 31 ） ,24 h （0.82 ± 0. 42 ） ,48 h （0.76 ± 0. 39 ） post - CPB compared with that of pre - CPB （ t = 1. 227,0. 563, 0.602 P, 〉0.05）. （A -aDO2 ） ： there were no significant differences at 2 h（156.10 ± 148.48） ,6 h（141.46 ± 133.52） compared with thatofpre-CPB（125.53±70.85）（t=1.532,0.869 P 〉0.05）,12h（96.33±76.09）,24h（98.63±75.73）,48 h（100.77±69.48） post - CPB were significandy lower than that of pre - CPB（ 125.53 ± 70. 85） （t = 2. 316,2. 139,2.058 Pa 〈0.05）. RI： 2 h（0.90 ±0.73） ,6 h （0.86 ±0.69）post-CPB were significantly higher than that ofpre- CPB（0.41 ±0.20）（t =5.338,5. 165 P, 〈0.01）,there were no signiificant differences at 12 h（O. 49 ±0.41 ） ,24 h（O. 51 ±O. 46） ,48 h（O. 53 ±0. 49） compared with that of pre - CPB（t = 1. 446,1. 644,1. 870 Pa〉 0. 05）. Conclusions The early damage of lung function after CPB is obviously in infants. Accurate management of circulation and respiration are important for reducing acute lung injury and improving pulmonary function.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第13期1011-1012,1026,共3页
Journal of Applied Clinical Pediatrics
关键词
体外循环
肺功能
婴儿
cardiopulmonary bypass
pulmonary function
infant
