体外循环对室间隔缺损婴儿手术后肺功能的影响

目的评估体外循环(CPB)对是否合并肺动脉高压先天性室间隔缺损(V SD)婴儿手术后肺功能的影响。方法行V SD修补术婴儿20例,根据是否合并肺动脉高压分为肺动脉高压组和无肺动脉高压组,每组各10例。分别于CPB前、CPB后3 h、6 h、9 h、12 h、15 h、18 h、21 h和24h测定肺功能,并记录手术后机械通气时间和重症监护时间。结果CPB前无肺动脉高压组婴儿肺功能各项指标显著优于肺动脉高压组(P<0.01),但CPB后各时间段除呼吸指数(R I)外其它指标均较术前显著降低(P<0.05),尤以CPB后9 h、12 h和15h较明显(P<0.01)。肺动脉高压组CPB后3h肺功能指标较CPB前改善,但在CPB后9h、12h和15h仍明显较CPB前差(P<0.05);CPB后21h、24h两组婴儿肺功能指标开始接近CPB前。结论CPB对V SD婴儿术后肺功能均有不同程度的损害,但对合并肺动脉高压的婴儿,手术带来的益处超过了CPB对肺的损害;积极改善术后心功能,可避免术后肺功能低谷的出现;若术后心功能稳定、无反应性肺动脉高压和肺动脉高压危象的发生,术前合并肺动脉高压的婴儿同样也能早期撤离呼吸机。

Effect of Cardiopulmonary Bypass on Pulmonary Function after Ventricular Septal Defect Repair in Infants

Objective To evaluate the effect of cardiopulmonary bypass(CPB) on pulmonary function in infants with variable pulmonary arterial pressure resulting from congenital ventricular septal defect(VSD).Methods Twenty infants with VSD underwent corrective surgery were divided into pulmonary hypertension group((n=10)) and non-pulmonary hypertension group((n=10)) according to with pulmonary hypertension or not.Pulmonary function was measured before CPB,3h,6h,9h,12h,15h,18h,21h,and 24h after CPB and duration for mechanical ventilation and cardiac intensive care unit stay were recorded.Results Pulmonary function parameters before CPB in non-pulmonary hypertension group were superior to those in pulmonary hypertension group(P<0.01),and pulmonary function parameters after CPB deteriorated than those before CPB(P<0.05),especially 9h,12h and 15h after CPB(P<0.01).Compared to pulmonary function parameters before CPB,pulmonary function parameters of pulmonary hypertension group at 3h after CPB were improved(P>0.05),but they deteriorated at 9h,12h and 15h after CPB(P<0.05).Pulmonary function parameters at 21h and 24h after CPB was recoverd to those before CPB in two groups.Conclusions Although exposure to CPB affects pulmonary function after VSD repair in infants,the benefits of the surgical correction to patients with pulmonary hypertension outweigh the negative effects of CPB on pulmonary function.Improvement of cardiac function can avoid the nadir of pulmonary function decreasing.The infants with pulmonary hypertension will be weaned off from mechanical ventilator as soon as possible,if hemodynamics is stable,without the responsive pulmonary hypertension or pulmonary hypertension crisis after operation.