婴幼儿急诊心脏手术效果及术前机械通气对预后的影响  

Therapeutic Efficacy of Emergency Heart Operation for Infants and Impact of Preoperative Mechanical Ventilation on Prognosis

作　　者：王显悦[1] 毕生辉[1] 王晓武[1] 梁爱琼[1] 梅鲁刚[1] 徐宇[1] 张卫达[1] 

机构地区：[1]广州军区广州总医院心脏外科中心

出　　处：《华南国防医学杂志》2012年第6期553-556,共4页Military Medical Journal of South China

基　　金：广州市科技计划重点项目(2011J4100021);天普研究基金项目(01201122)

摘　　要：目的明确婴幼儿急诊心脏手术治疗效果以及术前机械通气对预后的影响。方法随机抽取2009-03月以来于作者中心急诊手术治疗的先天性心脏病婴幼儿,按术前是否给予机械通气分为呼吸机组(30例)和常规组(35例)。观察和随访两组患儿治疗效果。记录并分析两组患者入监护室即时血气分析指标包括:动脉血氧分压(arterialoxygen pressure,PaO2)、二氧化碳分压(pappen-heimer CO2,PCO2)、乳酸(lactic acid,LAC)和酸碱度(pH);两组患者手术后呼吸相关指标和恢复情况包括:入监护室即时气道压力峰值(Ppeak);术后机械通气时间和监护室滞留时间;肺部感染发生例数。结果两组患儿手术相关死亡5例(7.69%)。呼吸机组死亡2例,余均治愈出院,术后3个月随访15例效果良好;常规组死亡3例,余均治愈出院,术后3个月随访20例效果良好。与常规组比较,呼吸机组患儿入监护室即时动脉血PaO2明显较低、Ppeak较高、术后机械通气时间和监护室滞留时间较长(P均<0.05),两组PCO2、LAC、pH、肺部感染发生例数无明显差异(P>0.05)。结论婴幼儿急诊心脏手术风险大。术前机械通气患儿术后早期呼吸功能差,恢复缓慢,但肺部并发症发生率和手术死亡率无增高。Objective To identify the therapeutic efficacy of emergency heart operation for infants and the effect of preoperative mechanical ventilation on prognosis. Methods The infants undergoing the emergency heart operation in our department from March 2009 were randomly divided into ventilation group（30 cases） and control group（35 cases） with or without preoperative ventilation treatment.The effects of arterial switch operation and followup examinations of the two groups were observed.The records of the arterial blood gas of the infants when they arrived at Intensive Care Unit（ICU） were compared and analysed in terms of arterial oxygen pressure（PaO2）,pappen-heimer CO2（PCO2）,lactic acid（LAC） and pH.Respiratory data and recovery condition such as respiratory peak pressure of airway（Ppeak） in the same ventilation condition at ICU admission,ventilation time,ICU time,frequency of pulmonary infection were observed and analysed. Results Among all the infants,five cases（7.69%） died after operation.In ventilation group,2 cases died,the others were clinically cured,and 15 cases had well therapeutic effect in the follow-up examinations 3 months later.In the control group,3 cases died,the other children were clinically cured,and 20 cases had well therapeutic effect in the follow-up.Compared with the control group,the ventilation group had lower PO2 value and higher Ppeak at ICU admission,and longer ventilation time and ICU time（P0.05）.There was no significantly difference between two groups in PCO2,LAC and pH at ICU admission and incidence of post-operation pulmonary infection（P0.05）. Conclusion There is high mortality risk of the emergency heart operation for infants.The infants with preoperative mechanical ventilation have bad respiratory function early after operation and recover slowly.Preoperative mechanical ventilation has no effect on pulmonary infection and post-operation mortality for those infants.

关 键 词：机械通气 急诊手术 肺部感染 

分 类 号：R654.2[医药卫生—外科学]