高频振荡通气在先天性心脏病体外循环术后重度肺损伤中应用  

Effect of high-frequency oscillatory ventilation on severe pulmonary injury after cardiopulmonary bypass for congenital heart disease

作　　者：朱耀斌[1] 罗朝峰 范祥明[1] 李志强[1] 李晓锋[1] 刘扬[1] 苏俊武[1] 张晶[1] 刘迎龙[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京市100029 [2]清华大学第一附属医院放射科,北京市100016

出　　处：《中华实用诊断与治疗杂志》2012年第12期1171-1173,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都医科大学基础-临床科研合作基金项目(11JL50);国家自然科学基金项目(30471721);国家自然科学基金项目(30670928);国家自然科学基金项目(81070055);科研基地-科技创新平台项目(PXM2011_014226_07_000060);北京市自然科学基金资助项目(7112046;7122056);北京市医药产品和技术重大项目培育研究项目(Z101107050210020);北京市科委首都市民健康项目(Z111100074911001);北京市卫生系统高层次卫生技术人才培养计划(领军人才2011-1-4);首都医科大学附属北京安贞医院院长科技发展基金(2012Z02)

摘　　要：目的评价高频振荡通气治疗先天性心脏病体外循环术后重度肺损伤的效果。方法体外循环术后出现重度肺损伤的先天性心脏病患儿18例,常规机械通气治疗无效后采用高频振荡通气治疗,观察治疗前、后血气指标变化、高频振荡通气治疗时间及并发症发生情况。结果存活11例,死亡7例,其中4例死于多器官功能衰竭,另3例分别死于肺动脉高压危象、肺静脉梗阻、肺出血;高频振荡通气时间为46～243(126.4±66.32)h;高频通气前pa(O2),pa(CO2)及pa(O2)/FiO2分别为(8.38±2.84)kPa,(7.73±2.26)kPa及0.87±0.12,高频通气后分别为(15.78±5.84)kPa,(5.96±1.03)kPa及0.51±0.16,差异均有统计学意义(P<0.05)。结论体外循环术后出现重度肺损伤且常规机械通气治疗无效的先天性心脏病患儿,尽早应用高频振荡通气治疗可改善患儿术后氧合和气体交换,改善患儿预后。Objective To evaluate the effect of high frequency oscillatory ventilation （HFOV） on severe pulmonary injury after cardiopulmonary bypass for congenital heart disease. Methods Eighteen pediatric patients with congenital heart disease were treated with HFOV when the conventional mechanical ventilation （CMV） was valid after cardiopulmonary bypass. Changes of blood gas indexes, HFOV treating time and the complications were observed. Results Eleven patients survived, and seven patients died, in which four died of multi-organ failure, one died of pulmonary hypertension crisis, one died of pulmonary vein ohstruction, and one died of pulmonary hemorrhage. All patients received high frequency oscillatory ventilation for 46 to 243 （126. 4±66. 32） hours. Pa （O2）, pa （CO3） and pa（O2 ）/FiO2 were （8.38±2.84） kPa, （7.73±2.26） kPa and 0.87±0.12 before frequency oscillatory ventilation, and （15.78±5.84） kPa, （5.96±1.03） kPa and 0. 514±0.16 after frequency oscillatory ventilation, which showed significant differences （P〈0.05）. Conclusion The pediatric patients with severe pulmonary injury should undergo HFOV as early as possible to improve ventilation and gas exchange when the conventional ventilation is valid after congenital heart surgery, which could improve the prognosis of patients.

关 键 词：先天性心脏病 体外循环术后 高频振荡通气 急性肺损伤 

分 类 号：R654.2[医药卫生—外科学]