保护性肺通气对婴儿围体外循环期肺功能的影响

目的 观察体外循环(CPB)中间断肺通气对婴儿肺功能的影响.方法 选取60例1岁以内行室间隔缺损修补术的患儿,分为2组:对照组(n=30)于CPB开始后停止通气;处理组(n=30)于CPB开始心脏停跳后膨肺[用手挤压气囊,使气道压力升到15～20 cm H2O(1 cmH2O=0.098 kPa),维持3～5 s,重复5次],将肺内血液排出,然后静态膨肺(3～5 cm H2O),并每隔10 min膨肺5次.两组患儿均于腔静脉开放后恢复机械通气.检测CPB开始前及CPB结束后2、6、12、24和48 h共6个时点的氧合指数、动脉血氧分压/肺泡氧分压、肺泡-动脉氧分压差和呼吸指数等肺功能指标.结果 在CPB后2、6、12 h,处理组氧合指数、动脉血氧分压/肺泡氧分压高于对照组(P＜0.05);在CPB后2、6、12、48 h,处理组肺泡-动脉氧分压差低于对照组(P＜0.05);在CPB后6、12 h,处理组呼吸指数低于对照组(P＜0.05).结论 在婴儿CPB过程中持续静态膨肺并间断压力膨肺,可以改善术后早期肺的氧合功能,有较好的肺保护作用.

Influence of static inflation and Intermittent ventilation on lung function during cardiopulmonary bypass in infants

Objective To investigate the impact of static inflation and intermittent ventilation on lung function peri-cardiopulmonary bypass(CPB) in infants.Methods Sixty infants of less than 1-year-old,with ventricular septal defect were selected to assigned to two groups:the treatment group(n=30),given static inflation and intermittent ventilation once every 10 minutes during CPB;the control group(n = 30),no ventilation during CPB.Indicators of pulmonary function including OI,PaO2/PAO2,A-aDO2 and RI were recorded before CPB and 2 h,6 h,12 h,24 h and 48 h after CPB.Results At 2 h,6 h,12 h after CPB,OI and PaO2/PAO2 of the treatment group were higher than those of the control group(P＜0.05).A-aDO2 of the treatment group was lower than that of the control group at 2 h,6 h,12 h,48 h after CPB(P＜0.05).RI of the treatment group was lower than that of the control group at 6 h,12 h after CPB(P ＜0.05).Conclusion Static inflation and intermittent ventilation during CPB can improve early oxygenation of lung,and have good lung protection in infants.