B-T分流术后体肺循环血流的调节  

Regulation of the distribution between pulmonary and systemic flow after blalock-taussig shunt operation

作　　者：李志浩[1] 徐志伟[1] 张海波[1] 郑景浩[1] 史珍英[1] 徐卓明[1] LI Zhi-hao;XU Zhi-wei;ZHANG Hai-bo;ZHENG Jing-hao;SHI Zhen-ying;XU Zhuo-ming(Intensive Care Unit of Cardiothoracic Surgery Department,Shanghai Children's Medical Center,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科监护室,200127

出　　处：《中华临床医师杂志（电子版）》2012年第22期7110-7113,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨Blalock-Taussig分流手术(B-T分流术)后通过呼吸机参数和血管活性药物的调节,维持适当的体肺循环血流量的分配,从而提高此类手术的生存率。方法总结2011年7月1日至2012年6月30日接受B-T分流术的连续57例患儿,术后通过呼吸机参数的调节,控制血气分析结果,使PCO2维持于50～55mmHg,pH维持于7.30～7.35,通过轻微的呼吸性酸中毒状态提高肺循环阻力从而限制肺血流;控制吸入氧浓度,使经皮氧饱和度(SpO2)维持在70%～80%。同时使用小剂量扩血管药物(米力农,硝普钠)降低体循环阻力,改善体循环灌注。结果全组死亡13例,死亡率22.8%。急诊手术死亡5例(35.7%),选择性手术死亡8例(18.6%);同时伴有动脉导管未闭的病例,不论导管结扎与否死亡率相同。结论 B-T术后维持适当的体肺循环比例是术后监护的关键,单纯控制肺循环阻力可能存在潜在的不利影响,如果结合对体循环阻力的调节可能会有更好的效果。Objective Searching an optimal balance between pulmonary and systemic flow through ventilator parameter adjustment and inotropic agents titration after Blalock-Taussig shunt,in order to improve its survival rate.Methods Summarize a consecutive series of 57 cases who received Blalock-Taussig shunt between July.1st,2011 and June.30th,2012.Regulated ventilator parameter to control the gas-check outcome,making PCO2 in 50-55 mm Hg;pH:7.30-7.35.Inducing light respiratory acidosis to elevate the pulmonary resistance to limit pulmonary flow;control the inspired oxygen concentration to make transcutaneous oxygen saturation maintain between 70%-80%.Meanwhile,using a little dose of vasodilator agents(such as milrinone and nitroprusside)to decrease systemic resistance to improve body perfusion.Results 13 cases died,mortality was 22.8%.In emergency cases,5 died,mortality 35.7%,in selective surgery cases,8 died,mortality 18.6%.The mortality is the same in patients suffered patent arterial duct whether their duct was ligated or not.Conclusions Suitable adjustment of pulmonary and systemic flow ratio is the key point in intensive care after Blalock-Taussig shunt.Depending on pulmonary resistance regulation may exist potential risk,whereas combined with systemic flow regulation may present a better outcome.

关 键 词：肺循环 体循环阻力 Blalock-Taussig 分流手术 

分 类 号：R726.5[医药卫生—儿科]