超滤对肺动脉高压患儿呼吸动力学的影响

目的观察超滤对肺动脉高压患儿体外循环术后呼吸动力学的影响.方法45例先天性室间隔缺损患儿,行心内直视室间隔修补手术,年龄1～8岁,其中15例术前无肺动脉高压为一组(C),30例术前有轻-中度肺动脉高压,随机分为两组(G1,G2),每组15例,其中一组(G1)体外循环中予以超滤.分别测定麻醉诱导后10 min(T0),体外循环后10 min(T1)、30 min(T2,术毕(T3),术后4 h(T4)的呼吸指数(RI)、气道平均压(Pmean)、胸肺顺应性(CL)及气道阻力(Raw).结果三组患儿呼吸指数在CPB后均升高,Pmean、CL及Raw均有不同程度改变,G2组高于C组及G1组,T1、T3、T4差异有统计学意义(P＜0.05),对照组变化程度最轻,超滤组变化程度小于非超滤组.结论超滤可减轻肺动脉高压患儿体外循环术后肺功能的影响.

The effect of ultrafiltration on pneodynamics after cardiopulmonary bypass in pulmonary hypertension children

Objective To observe the pneodynamic effect of ultrafiltration on patients after cardioplmonary bypass in children with pulmonary hypertension. Methods Thirty children with congenital heart disease ventricular septal defect and secondary pulmonary hypertension, aged 1-8 years, were recruited and divided into two groups randomly, modified ultrafiltration during and after bypass (G1, n=15)was applied in one group and not in the other group (G2, n= 15),15 children have normal pulmonary pressure served as control(group C, n=15) without ultrafiltration, Side stream spirometry (SSS) was applied to test mean airway pressure (Pmean), thoracic pulmonary compliance (CL) and airway resistance (Raw) in three groups before the operation and immediately after modified ultrafiltration (experimental group) or after bypass (control group). Respiratory index [P(A-a)DO2/PaO2] was calculated at 10 min after anesthesia induction (T0), 10 min(T1) and 30 min(T2) after CPB(T3), termination of surgery(T4)and four hours after surgery(T5). Results Mean airway pressure(Pmean), thoracic pulmonary compliance(CL) and airway resistance (Raw)changed differently after operation in three groups. But the extent of change in G1 group was significantly less than that in G2 group. Conclusion The damage of the lung caused by cardiopulmonary bypass is unavoidable. Using ultrafiltration in children's open heart operation can reduce the damage and improve the pulmonary function after bypass.