小儿肺血减少性青紫型先天性心脏病呼吸衰竭时的机械通气分析

目的　 探讨小儿肺血减少性青紫型先天性心脏病 (CHD)呼吸衰竭机械通气策略。 方法 　回顾性总结我院 1992 1998年间 12例小儿肺血减少性青紫型CHD合并呼吸衰竭患儿机械通气治疗效果 ,分析通气时机、方法、参数调节及药物治疗等对转归的影响。 结果 　机械通气后SaO2 >7%9例 (占 75 %) ;<70 %3例 ,其中 2例表现通气不足。在SaO2 >85 %的 5例中 ,2例表现通气过度或气压伤。通气时间 1 5h～ 5d。结果 1例顺利撤机 ,1例急诊手术治疗 ,5例死亡。余 5例放弃治疗 ;其中 1例因复苏过晚 ,持续昏迷。 6例TOF静脉应用新福林 ,仅使用最小剂量的 1例顺利撤机。 结论 　常规供氧及药物治疗无效者 ,应及时机械通气 ;通气压力、潮气量及PEEP均不宜过大。适宜的SaO2 ,参考值为 75 %～ 85 %。新福林不宜大剂量长程使用。部分病例需外科紧急干预。

Analysis of the effects of mechanical ventilation on children with respiratory failure and cyanotic congenital heart defects with decreased pulmonary blood flow

Objective To investigate key techniques of mechanical ventilation on children with cyanotic congenital heart defects with decreased pulmonary blood flow complicated by respiratory failure.Methods The time of ventilation starting,modes of ventilation,parameter adjustment and medication were retrospectively analysed on total of 12 cases.Results The SaO-2 raised higher than 70% after ventilation in 9 cases;and lower than 70% in 3,in which 2 presented hypoventilation.Among 5 cases with SaO-2 higher than 85% 2 had hyperventiliation and/or barotrama.The duration of ventilating on patients varying from 1^5 h to 5 d.Only 1 case was weaned from ventilator successfully;1 cured by emergent surgical intervention,and 5 died.Five cases withdrew from the therapy,in which 1 was in persistent coma after resuscitation.6 were treated with phenylephrine but only 1 with least dose weaned from ventilator.Conclusion If routine O-2 therapy and medication were not effective,mechanical ventilation should be given in time using adequate PIP,Vt and PEEP level.Ideal SaO-2 is in the range from 70% to 85%.It is indicated that large dose and long term sing of phenylephrine are not much better.Emergent surgical intervention is critical to some cases.