改良的保护性肺通气策略对婴幼儿体外循环术后急性呼吸窘迫综合征的疗效  

Modified lung protective strategies for infants with acute respiratory distress syndrome after cardiopulmonary by-pass

作　　者：邢泉生[1] 曹倩[1] 荣佑宝[1] 李贞福[1] 纪志娴[1] 泮思林[1] 

机构地区：[1]青岛大学医学院附属医院心脏外科,266003

出　　处：《国外医学（心血管疾病分册）》2004年第3期177-180,共4页

基　　金：基金项目:国家自然科学基金(编号:30070752);国家卫生部优秀青年科技人才专项基金(编号:1999BA2CKA1)

摘　　要：目的:探讨改良“保护性肺通气策略”的可行性,并评价其对婴幼儿体外循环术后急性呼吸窘迫综合征(ARDS)的治疗效果。方法:对17例先天性心脏病术后合并ARDS的婴幼儿采用新的通气模式:(1)低潮气量(6～8ml/kg);(2)高PEEP(6～12cmH_2O);(3)限制气道峰压(<30～35cmH_2O);(4)高呼吸频率(25～40次/分钟);(5)适当允许高碳酸血症(PaCO_2≤60mmHg)。同时注重液体限制、体位疗法等辅助措施,并在部分危重患儿及时应用外源性肺表面活性物质和(或)一氧化氮。结果:术后平均应用呼吸机时间12.73天。与以往同类病例的治疗结果相比,本组患儿无死亡,并发症发生率降低,无明显后遗症,近远期随访均满意。结论:在改良的保护性肺机械通气的基础上,辅以液体限制、外源性肺表面活性物质、一氧化氮等综合治疗手段,可以明显提高体外循环术后ARDS的治疗效果。Objective: The aim of this study is to summarize the experience of a new lung protective strategy for infant patients with ARDS after cardiopulmonary bypass. Methods: We studied 17 infant patients with ARDS after cardiopulmonary bypass. The modified maneuvers in mechanical ventilation were as follow. (1) Low tidal volume (6~8ml/kg), (2) High PEEP (6~12cmH2O), (3) Inspiratory peak pressure (<30~ 35cmH2O), (4) High respiratory frequency (25-40/min). On the other hand, exogenous pulmonary surfactant (100mg/kg) and (or) nitric oxide (20ppm) were given in 6 severe patients as additional therapy. Re-sults:In these patients, no early and later deaths were observed. Only one (1/17) infant had barotrauma in the early stage of ARDS. Conclusions: The latter understanding for pathological changes of the lungs of ARDS is helpful to develop the new mechanical ventilation strategy. Combined modified protective lung ventilation strategy with surfactant and(or) nitric oxide were more effective therapies.

关 键 词：保护性肺通气 婴幼儿 体外循环术 急性呼吸窘迫综合征 一氧化氮 肺表面活性物质 

分 类 号：R726.5[医药卫生—儿科]