小儿Denis Browne微创小切口心内直视手术对肺功能的影响

目的观察小儿体外循环心内直视手术采用右腋下Denis Browne微创小切口径路对肺功能的影响。方法选择2004年3月至2006年5月间60例小儿先天性心脏病患者，按切口方式分为右腋下Denis Browne微创小切口径路组（右侧切口组）和正中切口组，每组各30例。均在体外循环下完成心内直视手术，根据在麻醉诱导后、体外循环转流前、主动脉开放心脏复跳时、关胸前、术后30min、4h、2h7个时间点的血气分析结果及给氧浓度计算氧合指数（Oxygenation index，OI）、肺泡-动脉血氧分压差（Alveolararterial oxygen tension gradient，P（A-a）O2）、呼吸指数（respiratory index，RI），并观察呼吸机辅助时间、气管导管拔除后呼吸情况的改变，包括自主呼吸频率、有无呼吸困难、肺部哕音、紫绀以及动脉氧血红素饱和度、脉动氧血红素饱和度变化。结果两组均在体外循环下完成心内直视手术，无手术死亡，无严重并发症，术后均恢复良好。两组患儿OI均较术前降低，P（A-a，O2、RI较术前升高，两组患儿间无统计学意义；呼吸机辅助时间、气管导管拔除后呼吸情况的改变两组患者间无统计学意义。结论小儿体外循环心内直视手术采用右腋下Denis Browne微创小切口不加重术后肺功能的损伤。

Effect of Right Subaxillary Denis Browne's Small Incision for the Cardiac Operation on Lung Functional Impairment After Cardiopulmonary Bypass in Children with Congenital Heart Disease

Objective To investigate the effects of right subaxillary Denis Browne＇ s small incision for cardiac operation on lung functional impairment after cardiopulmonary bypass（CPB） in children with congenital heart disease（CHD）. Methods From March 2004 to May 2006, 60 patients with CHD underwent cardiac operation under CPB. They were randomized into two groups（ n = 30 each） ： fight subaxillary Denis Browne＇ s small incision group and median sternotomy incision group. The basic variables were similar between both groups. In right subaxillary small incision group, all the cardiac defects were repaired through right subaxillary small Denis Browne＇s incision thoracotomy with hypothermic cardiopulmonary bypass with aortic cross-clamping. Anesthesia was standardized, and ventilator settings, including the fraction of inspired oxygen, were kept constant throughout the study period. Oxygenation index（ OI = PaO2/FiO2 ）, alveolar-arterial oxygen tension gradient（ P（A-a） 02） and respiratory index（ RI = P（A-a） O2/PaO2） were calculated at anesthetic induction, pre- CPB, aortic declamping, chest closure, then at 30min, 1 h, 2h after skin closure. The duration of postoperative mechanical ventilation and clinical lung functional parameteras in the intensive care unit were also evaluated. Results The operations were successfully performed with good exposure. There was no operative or late mortality or major morbidity. In both groups, compared with the baseline, the levels of RI ＇and P（A-a） O2 gradually increased at aortic declamping and still maintained a high level at 2h after surgical intervention, the levels of OI gradually decreased at all assessment times. The change degrees of OI, RI and P（A-a） O2 were not significant between the two groups （P 〉 0. 05）. Conclusion These cardiac defects can be repaired effectively through right subaxillary Denis Browne＇ s small incision thoracotomy and the technique does not have detrimental effects on clinical lung function postoperatively