体外循环期间保持机械通气对学龄前先天性心脏畸形矫治术患儿术后肺部并发症发生率的影响  

Effect of Mechanical Ventilation During Cardiopulmonary Bypass on the Incidence of Postoperative Pulmonary Complications in Preschool Children Undergoing Correction of Congenital Heart Malformations

作　　者：王蕾 肖婷 杜真 陈政 屈双权 WANG Lei;XIAO Ting;DU Zhen(The Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children's hospital),Changsha Hunan 410007)

机构地区：[1]中南大学湘雅医学院附属儿童医院,湖南长沙410007

出　　处：《医学临床研究》2024年第12期1889-1892,共4页Journal of Clinical Research

摘　　要：【目的】探讨体外循环(CPB)期间保持机械通气对行先天性心脏畸形矫治术的学龄前期患儿术后肺部并发症(PPCs)、动脉氧合以及术后预后的影响。【方法】前瞻性选取2023年7月至2024年7月在本院心胸外科拟行侧切口先天性心脏畸形矫治术的64例患儿,采用随机数字表法将其分为观察组(CPB期间阻断上下腔后继续机械通气)和对照组(CPB期间阻断上下腔后未继续机械通气),每组32例。比较两组围术期指标、PPCs发生率,以及CPB开始(T_(0))、阻断上下腔静脉(T_(1))、阻断主动脉(T_(2))、CPB结束(T_(3))、手术结束(T_(4))、术后1 h(T_(5))的氧合指数(PaO 2/FiO 2)。【结果】观察组患儿术后机械通气时间、心胸外科监护室(CCU)停留时间均短于对照组,C反应蛋白、乳酸水平低于对照组,术后血管活性药-正性肌力药评分(VIS)低于对照组,差异有统计学意义(P<0.05)。观察组患儿PPCs发生率低于对照组,差异有统计学意义(P<0.05)。T_(2)、T_(3)、T_(4)、T_(5)时,观察组PaO 2/FiO 2均显著高于对照组,差异有统计学意义(P<0.05)。【结论】在体外循环期间保持机械通气能够降低PPCs发生率,可改善儿心脏畸形矫治术患儿的预后。【Objective】To investigate the effects of mechanical ventilation during cardiopulmonary bypass(CPB)on postoperative pulmonary complications,arterial oxygenation and postoperative prognosis in pre-school children undergoing correction of congenital heart malformations.【Methods】A total of 64 children undergoing lateral incision correction for congenital heart malformations in the Department of cardiothoracic Surgery of our hospital from July 2023 to July 2024 were prospectively selected and divided into the observation group(continued mechanical ventilation after upper and lower cavities were blocked during CPB)and the control group(no continued mechanical ventilation after upper and lower cavities were blocked during CPB)by random number table method,with 32 cases in each group.Perioperative indexes,postoperative pulmonary complications,and oxygenation index(PaO 2/FiO 2)at the beginning of CPB(T_(0)),occlusion of upper and lower vena cava(T_(1)),occlusion of aorta(T_(2)),end of CPB(T_(3)),end of surgery(T_(4)),and 1 h after surgery(T_(5))were compared between the two groups.【Results】The postoperative mechanical ventilation time and CCU residence time in the observation group were shorter than those in the control group,the levels of C-reactive protein and lactic acid were lower than those in the control group,and the postoperative vasoactive drug-positive inotropic drug score(VIS)was lower than those in the control group,with statistical significance(P<0.05).The incidence of PPCs in observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).T_(2),T_(3),T_(4),T_(5),PaO 2/FiO 2 in the observation group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).【Conclusion】Mechanical ventilation during cardiopulmonary bypass can reduce the incidence of postoperative pulmonary complications and improve the prognosis of children undergoing correction of cardiac malformation.

关 键 词：心脏缺损 先天性 心脏外科手术 肺疾病 手术后并发症 呼吸 人工 

分 类 号：R725.411[医药卫生—儿科]