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目的探讨婴幼儿体外循环手术围术期影响呼吸功能的因素及呼吸功能保护策略。方法本文以婴幼儿呼吸道解剖学与病理生理学特点为基础,对不同先天性心脏病及麻醉与体外循环对该类患儿呼吸功能的影响进行全面系统分析,提出心脏手术后呼吸管理策略与方法,如术中的肺保护措施、呼氧末正压(PEEP)的应用、适当过度通气、大心脏患儿采用俯卧位通气、重度低氧血症患儿及时应用外源性肺表面活性物质、肺泡复张手法的应用、气管镜吸痰等策略及方法。结果通过上述策略与方法的实施,我科婴幼儿术后呼吸道管理与早期相比,有了显著进步,机械通气时间由以往的(19.2±6.4)h,减少到(11.9±2.5)h(P<0.01),ICU时间由(7.2±3.9)d,下降到(4.1±2.6)d(P<0.01),手术死亡率由5.6%(44/790)下降到3.9%(23/584,P<0.05)。结论围术期有多种因素影响先天性心脏病患儿呼吸功能,早期就开始注意肺保护功能,将会收到明显效果。
Objective To investigate the influencing factors of respiratory function and respiratory protection strategies during perioperative period in infants with cardiopulmonary bypass. Methods Based on the anatomical and pathophysiological characteristics of respiratory tract in infants and young children, the paper systematically analyzed the effects of different congenital heart diseases and anesthesia and cardiopulmonary bypass on respiratory function in children with respiratory diseases. The strategies and methods of respiratory management after cardiac surgery were proposed. Such as intraoperative lung protection measures, the application of positive end-expiratory pressure (PEEP), appropriate hyperventilation, large heart children with prone position ventilation, severe hypoxemia in children with timely application of exogenous pulmonary surfactant, alveoli The application of the technique of double-retrenchment, bronchoscopy suction and other strategies and methods. Results Through the implementation of the above strategies and methods, postoperative respiratory management in infants and young children in our department improved significantly compared with the early stage, and the duration of mechanical ventilation decreased from 19.2 ± 6.4 h to 11.9 ± 2.5 h (P 0.01). The ICU time decreased from (7.2 ± 3.9) d to (4.1 ± 2.6) d (P <0.01), and the operative mortality decreased from 5.6% (44/790) to 3.9% (23/584, P < 0.05). Conclusion There are many factors that influence the respiratory function of children with congenital heart disease during perioperative period. Early attention to lung protection function will be achieved.