地塞米松预充对小儿心脏手术肺氧合功能的影响  

Effect of dexamethasone preloading on pulmonary oxygenation function in pediatric cardiac surgery

作　　者：赵歆 徐净[1] 邓奇[1] 章晓华[2] ZHAO Xin;XU Jing;DENG Qi;ZHANG Xiaohua(Department of Anesthesiology,Guiyang Maternal and Child Health Hospital,Guiyang,Guizhou 550003,China;Department of Cardiovascular Surgery,Guangdong Institute of Cardiovascular Disease,Guangdong,Guangzhou,Guangdong 510080,China)

机构地区：[1]贵阳市妇幼保健院麻醉科,贵州贵阳550003 [2]广东省心血管病研究所心外科,广东广州510080

出　　处：《现代医药卫生》2024年第20期3486-3489,共4页Journal of Modern Medicine & Health

摘　　要：目的观察体外循环体外循环(CPB)预充液中应用地塞米松对小儿心脏手术肺氧合功能的影响,为临床实践提供相应的依据。方法选取2023年2月至2024年1月贵阳市妇幼保健院心脏中心收治的行室间隔缺损修补术和(或)房间隔缺损修补术的先天性心脏病(CHD)患儿54例作为研究对象,随机将其分为对照组和地塞米松组,每组27例。对照组未给予地塞米松治疗,地塞米松组预充液中加入5 mg/kg地塞米松,分别于麻醉诱导后CPB前(T_(0))、CPB 15 min(T_(1))、主动脉开放前5 min(T_(2))、CPB结束时(T_(3))、入重症监护室(ICU)后2 h(T_(4))取血样进行动脉血气分析,计算呼吸指数(RI)、氧合指数(OI)、动脉肺泡氧分压比值(PaO_(2)/PAO_(2),a/A),记录术前一般状况及围手术期参数。结果对照组RI指标在T_(2)时点为2.52±2.57,显著高于地塞米松组(1.39±1.42),差异有统计学意义(P<0.05);2组患者OI、a/A指标比较,差异均无统计学意义(P>0.05)。术后气管拔管率及ICU机械通气时间比较,差异均无统计学意义(P>0.05)。结论CPB预充液中给予地塞米松可在一定程度上在一定时间段内改善CPB后肺氧合功能。Objective To observe the effect of dexamethasone in cardiopulmonary bypass priming(CPB)solution on pulmonary oxygenation function in pediatric cardiac surgery,and provide corresponding basis for clinical practice.Methods From February 2023 to January 2024,54 children with congenital heart disease(CHD)underwent elective ventricular septal defect repair and/or atrial septal defect repair surgery were selected from the Heart Center of Guiyang Maternal and Child Health Hospital.All patients were randomly divided into two groups,with 27 cases in each group.The control group did not use dexamethasone,and 5 mg/kg dexamethasone was added to the priming solution in the dexamethasone group.Blood samples were taken before CPB(T_(0)),CPB for 15 minutes(T_(1)),aortic opening for 5 minutes(T_(2)),at the end of CPB(T_(3))and CPB ending for 2 hours(T_(4))after anesthesia induction,and arterial blood gas was analyzed,and respiratory index(RI)and oxygenation index(OI)were calculated.Results The RI index of the control group was 2.52±2.57 at T_(2),which was significantly higher than that of dexamethasone group(1.39±1.42),and the difference was statistically significant(P<0.05);There was no significant difference in OI index and a/A between the two groups of patients(P>0.05).There was no significant difference in postoperative tracheal extubation rate and the duration of mechanical ventilation in ICU(P>0.05).Conclusion Dexamethasone can improve the pulmonary oxygenation function after CPB to a certain extent for a certain period of time.

关 键 词：地塞米松 心脏手术 体外循环 预充液 肺氧合 

分 类 号：R541.1[医药卫生—心血管疾病]