鼻塞持续气道正压对室间隔缺损婴幼儿心肺功能的支持作用  

Cardiopulmonary effects of nasal continuous positive airway pressure in infants with ventricular septal defect

作　　者：崔威[1] 耿荣[1] 金兰中[2] 吴冀川[1] 陈贤楠[1] 

机构地区：[1]首都医科大学附属北京儿童医院急救中心,100045 [2]首都医科大学附属北京儿童医院功能科超声心动图室,100045

出　　处：《中华儿科杂志》2002年第11期678-681,共4页Chinese Journal of Pediatrics

摘　　要：目的　研究鼻塞持续气道正压 (NCPAP)对室间隔缺损合并心力衰竭 (简称心衰 )及Ⅱ型呼吸衰竭 (简称呼衰 )婴儿心肺功能的支持作用。方法　选择合并心衰、呼衰的室间隔缺损婴儿 9例进行NCPAP前瞻性自身对照研究。观察记录NCPAP应用前、应用期间及暂时撤断后临床症状、体征、动脉血气和心功能的变化。结果　应用NCPAP后 ,患儿呼吸频率由 (61± 5 )次 /min降至 (5 3± 4)次 /min (P <0 0 1) ;氧合指数 (PaO2 /FiO2 )由 (15 2± 3 9)mmHg升至 (2 16± 5 1)mmHg (P <0 0 1) ;PaCO2 下降 ,但差异无显著性 [由 (5 2 79± 10 0 7)mmHg降至 (5 0 5 8± 4 5 0 )mmHg,P >0 0 5 ];心率由 (172± 7)次 /min降至 (15 8± 5 )次 /min (P <0 0 5 ) ;左心室每搏输出量由 (10 5± 1 8)ml升至 (12 1± 2 0 )ml;心输出量由 (1 8± 0 3 )L/min升至 (1 9± 0 3 )L/min(P均 <0 0 5 )。结论　NCPAP可提高合并心衰及Ⅱ型呼衰的室间隔缺损婴儿的肺氧合功能及左心室泵血功能 ,不加重高碳酸血症 ;Objective To control effectively the congestive heart failure (CHF), which is one of the most severe complications of the ventricular septal defect (VSD) is clinically important to decrease the morbidity. CHF resulted from the ventricular overload is aggravated by some stimuli, such as bronchial pneumonia and the cardioplumonary interaction. It was hypothesized that the application of nasal continuous positive airway pressure (NCPAP) may be beneficial for the treatment, not only by improving oxygenation, but also by ameliorating cardiac function. This study aimed to evaluate the cardiopulmonary effects of NCPAP in infants with VSD. Methods Nine infants aged from 1.5-9 months and diagnosed VSD with CHF and respiratory failure were sedated for 30 min and, were given NCPAP at 5 cmH 2O for 30 min. The blood gas was measured and analyzed at the baseline, during NCPAP and 20 min later after the cessation of NCPAP. Cardiac function was determined by pulsed Doppler echocardiography. Results After the application of NCPAP, PaO 2/FiO 2 increased significantly [from (152±39) to (216±51) mmHg, P<0.01]. A significant decrease was found for the respiratory rate and heart rate [from (61±5) to (53±4) bpm, P<0.01; (172±7) to (158±5) bpm, respectively, P<0.05]. The decreased PaCO 2 was not significant [from (53±10) to (51±5) mmHg, P>0.05]. The stroke volume and cardiac output were elevated significantly [from (10.5±1.8) to (12.1±2.0)ml, (1.8±0.3) to (1.9±0.3)L/min, respectively, P<0.05]. The improvement of the cardiac function could not be predicted by any of the basic hemodynamic or clinical variables, nor was it related to random variation since all variables returned to the baseline after the cessation of NCPAP. Conclusion NCPAP might improve the oxygenation without the increase of PaCO 2, and offer a noninvasive adjunct for improving the left ventricular pumping function in infants with CHF and respiratory failure secondary to VSD.

关 键 词：气道阻力 室间隔缺损 充血性心力衰竭 呼吸功能不全 心排血量 

分 类 号：R725.4[医药卫生—儿科]