新生儿心脏术后呼吸管理策略  

The strategy for respiratory care in neonates after cardiac surgery

作　　者：史珍英[1] 蔡及明[1] 陈玲[1] 周燕萍[1] 徐卓明[1] 苏肇伉[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2004年第4期208-211,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委基金资助 ( 0 -2 41190 2 0 )

摘　　要：目的　探讨新生儿心脏术后呼吸管理策略。方法　复杂先天性心脏病 (先心病 )新生儿 5 3例 ,平均年龄 (14 71± 9 73)d ,平均体重 (3 34± 0 35 )kg。行心内畸形根治术 4 2例 ,姑息术 11例 ;体外循环超滤 4 6例 ,延迟关胸 2 4例。均采用同步间歇指令式通气 +容量控制 (SIMV +VC)模式辅助通气 ,12例病儿因气道压力高、低氧血症持续无改善而更改为同步间歇指令式通气 +压力控制 (SIMV +PC)模式。记录病例动脉血气指标、气道分泌物培养、呼吸机使用时间以及肺部并发症。结果　改用SIMV +PC病儿 ,氧合指数 (OI)和动脉血氧饱和度 (SatO2 )均较原SIMV +VC模式显著增高 (P <0 0 1) ,平均血气改善时间较SIMV +VC模式缩短 78 5 % (P <0 0 1)。延迟关胸病儿术后肺部并发症发生率和呼吸机使用时间与非延迟关胸者差异无显著性 (P >0 0 5 )。术后气管内分泌物培养 (ETT)阳性病儿呼吸机使用时间及喘息憋气发生率显著高于ETT阴性者。结论　体外循环超滤、延迟关胸技术直接和间接有助减轻肺功能损害。术后低氧、气道高阻力选用SIMV +PC有利于氧合功能的改善。控制肺部感染能缩短呼吸机辅助时间。Ovbective To discuss the strategy for respiratory care in neonates after cardiac surgery. Methods 53 neonates who underwent cardiac surgery for complex congenital heart defects were studied. The mean age was (14.71±9.73) day,and the mean weight was (3.34±0.35) kg. 42 patients had corrective operation and 11 had palliative operation. 86.8% of patients used ultrafiltration. 45.3% of patients had delayed sternal closure. Ventilation mode was changed from SIMV+VC to SIMV+PC in 12 neonates with high inspiratory pressure and hypoxemia. Artery blood gas analysis,airway secretion culture,mechanical ventilation time and pulmonary complication were recorded. Results 12 patients whose ventilation modes were changed had higher Oxygen Index (OI) in SIMV+PC mode compared to SIMV+VC mode (P<0.01). The mean time improving for blood gas analysis was significantly shorter in SIMV+PC mode,(P<0.01). There was no difference in the incidence of pulmonary complication and mechanical support time in patient with delayed sternal closure and non-delayed sternal closure (P>0.05). Ventilation time and the incidence of bronchial spasm were higher in patients with positive airway secretion culture than those with negative results. Conclusion Ultrafiltration and delayed sternal closure can decrease pulmonary injury directly or indirectly. SIMV+PC mode is beneficial for neonate with high airway pressure and hypoxemia. Control of pneumonia may reduce ventilation time.

关 键 词：新生儿 心脏手术 呼吸管理 复杂先天性心脏病 外科治疗 

分 类 号：R726.5[医药卫生—儿科]