小儿室间隔缺损修补术中肺受压时间对肺功能的影响  

Effect of Pulmonary Compression Time on Pulmonary Function during Repair of Ventricular Septal Defect in Children

作　　者：常新 董文通[1] 李现杰[1] 张润生[1] 冀攀 CHANG Xin;DONG Wentong;LI Xianjie;ZHANG Runsheng;JI Pan(Cardiac Surgery Department No.5,the 7th People′s Hospital of Zhengzhou,Henan Zhengzhou 450016,China)

机构地区：[1]郑州市第七人民医院心外五科

出　　处：《中国医药导刊》2019年第11期648-651,共4页Chinese Journal of Medicinal Guide

摘　　要：目的:观察小儿经右侧腋下直切口行室间隔缺损(VSD)修补术中肺受压时间对肺功能的影响。方法:选取2016年8月至2019年3月在我院行右侧腋下直切口VSD修补术的患儿167例,观察组80例,经右侧腋下直切口行VSD修补术,在缝合右房切口,开放上下腔静脉后,即剪断悬吊线,取出挡肺的湿纱布;常规组87例,在关闭主动脉插管切口后,剪断悬吊线,取出挡肺的湿纱布。同时查阅病历,记录经第4肋间进胸前(T1)、体外循环(CPB)开始前(T2)、CPB停止后30 min(T3)及术后3 h(T4)的动脉血气指标,并计算氧合指数(OI)及呼吸指数(RI),同时统计CPB时间、主动脉阻断时间,计算开放上下腔静脉至拔出主动脉插管的操作时间及转入监护室后呼吸机辅助呼吸时间。结果:观察组在开放上下腔静脉至拔出主动脉插管的操作时间上,与常规组相比差异无统计学意义;在T3、T4的OI较常规组升高,RI则较常规组降低,术后呼吸机辅助呼吸时间上缩短。结论:右侧腋下直切口行室间隔缺损修补术中,将挡肺的湿纱布在开放上下腔静脉后即取出,缩短肺受压时间,并未增加相应的操作时间,更重要的是可以减轻对肺功能的损伤。Objectives:To observe the effect of pulmonary compression time on pulmonary function during repair of ventricular septal defect(VSD)through right subaxillary incision in children.Methods:167 VSD children who underwent surgical repair of VSD through right subaxillary incision from August 2016 to March 2019 in our hospital were selected.Eighty patients who underwent repair of VSD were selected as the observation group,after the right atrial incision was closed and the superior and inferior vena cava were opened,the suspension lines were cut and the wet gauze for block the lung was taken out.In the conventional group of 87 patients,after closing the aortic cannula incision,the suspension lines were cut and the wet gauze for block the lung was taken out.At the same time,arterial blood gas index at before through the 4th intercostal into the chest(T1)and before cardiopulmonary bypass(CPB)(T2)and 30 min after CPB(T3)and 3 h after surgery(T4)were recorded by looking up medical records to calculate oxygenation index(OI)and respiratory index(RI).The CPB time and aortic cross-clamp time and mechanical ventilation time were recorded.The operation times between the opening of the superior and inferior vena cava and the removal of the aortic cannula were calculated.Results:Compared with the conventional group,there was no significant difference in the operation time between the opening of superior and inferior vena cava and the removal of aortic cannula in the observation group,OI at T3 and T4 were higher than those in the conventional group,while RI at T3 and T4 were lower than those in the conventional group,and postoperative ventilator assisted breathing time has shorter.Conclusion:The corresponding operation time has no increase when the wet gauze for block the lung was removed immediately after opening the superior and inferior vena cava and pulmonary compression time was decreased during repair of ventricular septal defect through right subaxillary incision,more importantly,these could reduce damage of pulmonary functio

关 键 词：室间隔缺损修补术 肺受压时间 肺功能 

分 类 号：R541.12[医药卫生—心血管疾病]