不同潮气量机械通气治疗重症先天性心脏病术后疗效分析

目的 探讨不同潮气量机械通气策略对手术后婴幼儿重症先天性心脏病（先心病）的疗效差别.方法 2010年10月至2012年1月我院CICU收治的先心病术后机械通气时间≥72 h、年龄≤3岁的患儿68例（男40例,女28例）.以不同潮气量的机械通气策略分为2组：A组32例,采用小潮气量（6～10 ml/kg）的通气策略,B组36例,采用大潮气量（10 ～ 15 ml/kg）,均采用压力调节容量控制模式,观察两组术后机械通气时间、ICU住院时间、术后并发症等.结果 B组机械通气时间为（8.6±2.5）d,A组为（11.7±3.2）d,B组较A组缩短,差异有统计学意义（P＜0.01）;B组ICU住院时间为（11.4±4.8）d,A组为（15.6±5.7）d,B组较A组缩短,差异有统计学意义（P＜0.01）.A组发生呼吸机相关性肺炎2例（6.3％）,气胸1例（3.1％）;B组发生呼吸机相关性肺炎2例（5.6％）,气胸2例（5.6％）;两组比较差异无统计学意义（P＞0.05）.结论 采用大潮气量机械通气策略治疗婴幼儿重症先心病术后的疗效优于小潮气量机械通气策略.

Comparison of different tidal volume mechanical ventilation strategy on infants with severe congenital heart disease after curative

Objective To analyse the difference of effects of different tidal volume mechanical ventilation strategies in infants with severe congenital heart disease after curative.Methods Sixty-eight cases were chosen from CICU of Anhui Provincial Children＇s Hospital during Oct 2010 to Jan 2012.Thirty-two cases in A group were used in ventilation strategy by lower tidal volumes （6 ～ 10 ml/kg）,36 cases in B group were used in ventilation strategy by larger tidal volumes （10 ～ 15 ml/kg）.The time of mechanical ventilation,duration of ICU stay and postoperative complications were compared between the two groups.Results The time of mechanical ventilation of B group was shorter than that of A group [（8.6 ± 2.5） d vs （11.7 ± 3.2） d],duration of ICU stay of B group was shorter than that of A group [（11.4 ± 4.8） d vs （15.6 ± 5.7） d],there were statistical differences between two groups（P ＜ 0.0l）.The incidence rate of ventilator associated pneumonia and pneumothorax were 6.3％ and 3.1％ in A group,which were 5.6％ and 5.6％ in B group,there were no statistical differences between two groups （P ＞ 0.05）.Conclusion The effects of mechanical ventilation with larger tidal volumes is better than that with lower tidal volumes in infants with congenital heart disease postoperative therapy.