小儿心内直视手术后急性呼吸窘迫综合征的危险因素与防治对策

目的 分析小儿心内直视手术后发生急性呼吸窘迫综合征(ARDS)的危险因素及探讨其防治对策.方法 以2001年1月至2008年10月间连续1 408例施行先天性心脏病(先心病)手术患儿为研究对象,进行术后ARDS危险因素的单因素分析和多因素Logistic回归分析.结果 术后发生ARDS 32例,发生率为2.27%.术后ARDS患儿病死率为46.9%.单因素分析显示:紫绀型先心病、体外循环时同、主动脉阻断时间、呼吸机通气时间、每公斤体质量引流液总量、围手术期意外、术后并发症与术后ARDS有关.经多因素Logistic回归分析显示:体外循环时间超过180 min、每公斤体质量引流液总量超过18 ml、围术期发生意外、术后多器官功能衰竭为小儿心内直视手术后ARDS的危险因素.结论 对于具有ARDS高危因素的心内直视手术患儿,应采取积极的防治措施,这对防止心内直视手术后发生的ARDS具有重要的意义.

Risk factors and management strategies for acute respiratory distress syndrome in children after car diopulmonary bypass

Objective To analyze the risk factors,prevention and management strategies of acute respiratory distress syndrome(ARDS)after cardiopulmonary bypass(CPB).Methods Between January 2001 and October 2008,1 408 patients undergoing open heart surgery were recruited for study.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Thirty-two patients (2.27%)developed ARDS.The mortality for ARDS was 46.9 %(15/32).Univariate risk factors included cyanotic congenital heart disease,CPB lime,aortic cross-clamping time,mechanical ventilation time,the volume of postoperative drainage per kilogram of body weight,perioperative unexpected events and postoperative complications.Multivariate logistic regression analysis showed that CPB time ＞ 180 rain,postoperative drainage volume per kilogram of body weight ＞ 18 ml,perioperative unexpected events,postoperative multiple organ dysfunction syndrome(MODS)were risk factors.Condusion Active and effective treatments should be carried out in the children with high risk factors of ARDS following open heart operation.It would play an important role in the prevention,early diagnosis and management of ARDS.