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目的 小儿心内直视手术麻醉期间应用ＰＥＥＰ和转流期间肺泡低压，寻找此类手术麻醉中改善肺表面活性物质（ＰＳ）生成和呼吸系统总顺应性（Ｃｒｓ）的途径。方法 ４０ 例左向右分流型先心病患儿随机分为４ 组，Ⅰ组为ＩＰＰＶ 通气组，Ⅱ组为ＰＥＥＰ应用组，Ⅲ组为ＩＰＰＶ通气且转流期间肺泡低压组，Ⅳ组为ＰＥＥＰ及转流期间肺泡低压组。测定各组各时点的Ｃｒｓ及ＰＳ生化指标。结果 Ⅰ组手术结束时Ｃｒｓ、饱和磷／总磷及饱和磷／总蛋白比值显著低于其他三组，同时显著低于诱导后基础值（Ｐ＜ ０．０５）。结论 认为此类手术应用ＰＥＥＰ和转流期间肺泡低压有利于改善患儿的呼吸功能及ＰＳ生成。
Purpose PEEP and alveolar hypoperfusion during bypass are sought during open heart surgery in order to find ways to improve pulmonary surfactant (PS) production and total respiratory compliance (Crs) during such surgical anesthesia. Methods Forty children with left-to-right shunt were divided into four groups at random: group Ⅰ was IPPV group, group Ⅱ was PEEP group, group Ⅲ was IPPV group, pulmonary alveolar group and group Ⅳ PEEP group Alveolar hypobaric pressure group during commutation. Crs and PS biochemical indexes at each time point were determined. Results The Crs, saturated phosphorus / total phosphorus and saturated phosphorus / total protein in group Ⅰ were significantly lower than those in the other three groups at the end of operation, and were significantly lower than those at baseline (P <0.05). Conclusions The use of PEEP during this procedure and the alveolar hypoperfusion during the bypass period are favorable for improving respiratory function and PS production in children.