肺高压小儿围术期低氧血症及处理

目的：为了提高先心病肺高压小儿围术期存活率，减少死亡率，探讨围术期低氧血症的原因及纠治低氧血症原则。方法：应用血气及肺动脉压力测定技术对４０例先天性心脏病室间隔缺损（ＶＳＤ）小儿（肺高压组２０例，肺动脉压正常组２０例）体外循环（ＣＰＢ）转流前、后血气及肺动脉压力变化进行了研究。结果：转流前，肺高压组ＰａＯ２明显低于对照组，Ａ－ａＤＯ２明显大于对照组。转流后，随着肺动脉压力降低，ＰａＯ２并无明显改善，肺高压组ＰａＯ２比对照组降低更为明显，Ａ－ａＤＯ２进一步加大。结论：上述结果可能与下列因素有关：（１）术前肺损伤较重；（２）ＣＰＢ加重肺损伤；（３）转后心功能降低。故加强围术期呼吸、循环管理至关重要。

The perioperative hypoxemia in children with congenital heart disease and pulmonary hypertension,and its treatment

Objective:In order to decrease the mortality of children with congenital heart disease and pulmonary hypertension during open heart surgery,the causes of perioperative hypoxemia were discussed and treatment principles were put forward Methods:The blood gas and pulmonary arterial pressure were measured in 40 children of ventricular septal defect(VSD) before and during CPB 20 of them were with pulmonary hypertension (PH group) and 20 cases without pulmonary hypertension(control group) Results:PaO 2 values in PH group were significantly lower than those of control group,A aDO 2 in PH group significantly higher than that of control group before CPB During CPB,with pulmonary arterial pressure reducing,PaO 2 in PH group became much more lower than that of control group Conclusion:Its results may be from following factors:1) before operation,pulmonery injuries in PH group are more serious than those in control group 2) pulmonary injuries become worsened during CPB 3) Following CPB,cardiac function decrease.Therefore,it is very important to strengthen respiratory and circulatory management during CPB