小婴儿先天性心脏病术后的呼吸管理

目的 总结年龄小于6个月的先天性心脏病患儿术后呼吸管理经验。方法回顾性分析550例小婴儿先天性心脏病术后呼吸道管理的临床资料，心内畸形根治术占95．6％，患儿手术时年龄11h至6个月，平均年龄（3．1±2．3）个月；手术时平均体重（4．3±1．5）kg，其中体重小于5kg316例。均使用了人工呼吸机支持，麻醉清醒前均采用压力控制（PC）模式，清醒后均采用同步间歇指令通气（SIMV）＋压力控制（PC）＋压力支持（PS）模式。结果本组治愈530例，死亡20例，死亡率约3．8％，其中死于呼吸功能衰竭5例；存活510例，术后合并肺部并发症23例（占4．3％），包括低氧血症5例，肺部感染7例，肺不张11例；再次气管插管8例。术后呼吸机辅助4～306h，平均20．8±19．3h，ICU停留时间36～384h，平均63．7±53．4h。结论呼吸道并发症是小婴儿先天性心脏病术后死亡的重要原因，重视术后呼吸道管理，有助于提高疗效，降低死亡率。

Postoperative intensive respiratory care of young infants with congenital heart disease

Objective The purpose of this study is to summarize the experiences of postoperative intensive respiratory care for young infants undergoing cardiac surgical therapy. Methods Retrospective analysis was performed on our institute clinical data, including 550 cases of young infants undergoing cardiac surgery, of which 95.6% were introcardiac corrective surgeries.Their age ranged from 11 hours to 6 months （mean age 3.1 ± 2.3 months） ,body weight ranged from 2.2 kg to 7.5 kg （mean weight 4.3 ± 1.5 kg）,and 316 cases weight was less than 5.0 kg.All of above cases,the ventilator setup were PC （Pressure Control） model before wakening from the anaesthesia and SIMV＋PC＋PS model after that. Results 20 infants died with the mortality of 3.8% ,and 5 of them were die d due to respiratory failure,Among 550 survivals, 23 cases associated with pulmonary complications, which containing 5 cases of hypoxemia, 7 cases of infection and 11 cases of pulmonary atelectasis.The cases of 3 hypoxemia and 5 low cardiac output recovered via the treatment of the tracheal re-intubatton and effective intensive respiratory care.For all of those successful healing,the ventilation time varied from 4 hours to 306 hours. （ mean time 20.8±19.3 hours）,ICU time varied from 36 hours to 384 hours （mean time 63.7±53.4hours）. Conclusions We should pay more attentions to the postoperative intensive respiratory care in the surgical therapy of young infants with congenital heart disease,Early diagnose and early intervention for any complications are key points of satisfied outcome.