先心病婴幼儿体外循环心脏手术前后呼吸机械力学的变化  

作　　者：赵璧君[1] 雷兰萍 金振晓[1] 熊红燕[2] 高照波[1] 陈敏[3] 邓超[1] 陈涛[1] 

机构地区：[1]西京医院心血管外科,710032 [2]西安市中心医院心胸外科 [3]西京医院麻醉科,710032

出　　处：《当代医学》2010年第4期13-16,共4页Contemporary Medicine

摘　　要：目的观察体外循环心脏手术对婴幼儿呼吸机械力学的影响。方法回顾分析2007年12月～2008年11月在西京医院心脏外科进行心脏畸形矫治的99例年龄<3个月的患儿手术前后呼吸机械力学参数的变化。分别在麻醉诱导后、手术结束关胸后和返回ICU后3个时间点测定患儿的肺动态顺应性和全肺阻力,并记录患儿年龄,体重,术前胸片浸润性改变情况,术前机械通气情况,术前肺血流量增高情况,体外循环时间,主动脉阻闭时间,深低温停循环时间和体外循环中超滤量等参数。结果体外循环心脏手术后,肺血流量增高,患儿的全肺阻力下降,年龄越小,改善越明显。而术前肺血流量正常或者降低的患儿,手术后肺动态顺应性下降。结论术后肺血流量增高,患儿体外循环心脏手术后呼吸机械力学参数改善,其改善程度超过了体外循环对肺的损伤程度。Objective Exposure to hypothermic cardiopulmonary bypass （CPB） adversely affects lung function. We designed this study to determine the changes in respiratory mechanics in infants younger than 3 months undergoing heart surgery. Methods Ninety-nine infant and newborn patients with congenital heart defects, admitted in the department of cardiovascular surgery of Xijing Hospital from December 2007 to November 2008, were included in this study. Dynamic respiratory compliance （Cdyn） and total respiratory resistance （Rrs） were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded： age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Results Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. Conclusion The benefits of surgical correction of pulmonary over circulation outweigh the negative effects of CPB on respiratory mechanics.

关 键 词：先天性心脏病 体外循环 肺功能 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]