高频振荡通气在小儿先天性心脏病术后的应用  

Application of High-Frequency Oscillatory Ventilation after Open Heart Surgery Treatment in Children with Congenital Heart Disease

作　　者：李胜利[1] 王旭[1] 贺彦[1] 刘迎龙[2] 李守军[2] 闫军[2] 

机构地区：[1]中国医学科学院阜外心血管病医院小儿心脏中心PICU,北京100037 [2]中国医学科学院阜外心血管病医院小儿心脏中心外科,北京100037

出　　处：《实用儿科临床杂志》2009年第12期954-955,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨高频振荡通气(HFOV)在小儿先天性心脏病术后的应用效果。方法2007年6月-2008年6月阜外心血管病医院小儿心脏中心实施心脏手术患儿1957例,其中实施HFOV13例。男8例,女5例;年龄(13.4±15.4)个月;体质量4.2～12.5kg。其中法洛四联症4例,大动脉转位3例(其中校正性大动脉转位1例),完全性肺静脉畸形引流、完全性心内膜垫缺损、肺动脉闭锁各2例。除1例肺动脉闭锁行体肺分流术外,其余手术均在全麻低温体外循环下进行,术后常规呼吸机辅助呼吸。采用SPSS11.5软件进行统计学分析。结果换HFOV前常频呼吸机辅助时间为(15.70±20.33)d,HFOV辅助时间为(10.0±7.5)d。高频通气早期可明显改善通气、换气功能,13例患儿中,存活5例,存活率38.4%。死亡病例中,6例死于肺实变,死于肾衰竭、肺出血各1例。7例并发气胸。结论HFOV在先天性心脏病患儿术后的应用,早期可获得满意通气换气功能;但病死率仍很高;远期效果差者,HFOV可作为过渡手段。Objective To explore the application of high - frequency oscillatory ventilation （ HFOV ） postoperatively after open heart surgery in children with congenital heart disease. Methods From Jun. 2007 to Jun. 2008, a total of 1 957 cases were operated in pediatric center of Fuwai cardiovascular hospital. Thirteen cases of 1 957 were given HFOV. Among these 13 patients,8 were male and 5 were female; Age was （ 13.4 - 15.4） months. The range of weight was 4.2 - 12.5 kg. Four cases were tetralogy of Fallot, 3 cases were transposition of the great arteries （1 case was corrective transposition of the great arteries） ,2 cases were total anomalous pulmonary venous connection,2 cases were total endocardial cushion defects,2 cases were pulmonary artery atresia, all patients were under cardiopulmonary bypass repaired operation except 1 patient with PAA under Blalock - Taussig procedure. All patients were mechanical ventilated after surgery. Results The duration of switching general mechanical ventilation to HFOV was （15.70 ± 20.33） days and patients continued to be on HFOV about （10.0 ± 7.5 ） days. In short term, the lung function of ventilation and gas exchange were be improved by HFOV,but the long -term result was not satisfactory due to a high mortality. There were 5 survived （38.4%） in this group. Six cases of the patients succumbed to consolidation of lung. The commonest complication was pneumothorax （7 cases）. Conclusions Short term of HFOV in children with congenital heart disease was satisfactory postoperatively. But there was a high mortality. HFOV can be regarded as a transition method for unsatisfactory long - term.

关 键 词：高频振荡通气 先天性心脏病 急性肺损伤 

分 类 号：R726.5[医药卫生—儿科]