高频震荡通气治疗先天性心脏病根治术后严重呼吸窘迫综合征  

High-Frequency oscillatory ventilation for children with severe acute respiratory distress syndrome after cardiac surgery

作　　者：李胜利[1] 王旭[1] 李守军[1] 闫军[1] 

机构地区：[1]中国医学科学院阜外心血管病医院小儿外科中心,北京100037

出　　处：《中华小儿外科杂志》2013年第8期578-581,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的回顾性评价高频震荡通气（HFOV）治疗先天性心脏病术后严重呼吸窘迫综合征的效果，以及比较肺高压型先天型和非肺动脉高压先天型先天性心脏病术后严重呼吸窘迫综合的征治疗差异。方法先天性心脏病根治术后严重呼吸窘迫综合征进行高频震荡通气治疗的64例，分为非肺动脉高压组（Ⅰ组）和肺动脉高压组（Ⅱ组），Ⅰ组33例，Ⅱ组31例。对两组比较分析。结果两组患儿一般临床资料对比差异没有统计学意义；Ⅰ组患儿HFOV时间明显短于Ⅱ组[（104．89±53．47）hl：L（386．49±125．36）h，P〈0．05]，Ⅰ组患儿的住院死亡率为21．2％，Ⅱ组患儿的住院病死率为64．5％，差异有统计学意义。结论HFOV治疗先天性心脏病根治术后呼吸窘迫综合征早期效果满意，从出院病死率看，其对非肺动脉高压患儿疗效优于肺动脉高压患儿。Objective To compare survival of patients with acute respiratory distress syndrome after corrective cardiac surgery treated by high-frequency oscillatory ventilation with pulmonary hyper- tension or without pulmonary hypertension. Methods Among 10827 patients, 64 with refractory acute respiratory distress syndrome were ventilated with high-frequency oscillatory ventilation. Patients with significant uncorrected residual lesions were not included. The patients were grouped according to car- diac diagnosis：group Ⅰ （n = 33）, non pulmonary hypertension patients; group Ⅱ （n = 31）, pulmonary hypertension patients. The demographic data, respiratory and circulatory parameters were recorded. The two groups were evaluated for survival rates at discharge as the primary outcome. Results There were no significant differences between the groups with respect to age, weight, central venous pres sure,left atrial pressure. The mean duration of high-frequency oscillatory ventilation was significantly shorter in group Ⅰ than that in group Ⅱ [（104. 89 ＋ 53.47）h vs （386. 49 ±125.36）h,P〈0. 05]. The patients in group Ⅱ showed higher mortality rate than that in group Ⅰ [7 vs. 20 （21.2% vs. 64. 5%） （P〈0. 05）]. Conclusions High-frequency oscillatory ventilation therapy for severe postoperative a- cute respiratory distress syndrome is effective following cardiac surgery.

关 键 词：心脏缺损 先天性 高频震荡通气 急性呼吸窘迫综合征 心脏外科手术 

分 类 号：R722.1[医药卫生—儿科]