漏气试验在儿童先心病术后的应用

Application of air leak test in postoperative children with congenital heart disease

目的研究儿童先心病术后早期带机期间气囊漏气试验(CLT)在机械通气脱机中的应用价值。方法选取唐山市妇幼保健院心脏外科2015年6月至2016年3月接受先心病手术后顺利脱机的患儿74例,按年龄分为A组(≥24个月)、B组(<24个月),观察两组术后即刻和拔管前CLT及拔管后上气道梗阻(UAO)发生情况。结果所有患儿均未发生UAO,≥24月者CLT皆阴性。两组返室时及拔管前CLT定性、定量结果均有统计学差异(P<0.05)。B组定性阳性与阴性患儿带机时间无统计学差异(P>0.05),定量阳性与阴性患儿带机时间亦无统计学差异(P>0.05)。结论 CLT结果与年龄有关,在<24个月患儿不同CLT结果对带机时间无明显影响,故不能作为拔管的必要条件,在轻症患儿,CLT对指导拔管作用不大。

Objective To explore the clinical application value of cuff leak test （CLT） in extubation of mechanical ventilation of congenital heart disease （ CHD ） children during early postoperative period with mechanical ventilation. Methods A total of 74 CHD children in whom mechanical ventilation successfully was removed after repair surgery in Tangshan Maternity and Child Health Hospital from June 2015 to March 2016 were selected and divided into group A （≥ 24 months） and group B （ 〈 24 months） according to children＇s age. CLT immediately after operation and before extubation and the occurrence of upper airway obstruction （UAO） after extubation were observed in two groups. Results None of the children developed UAO, and CLT was negative for children more than 24 months of age. There were significant differences in the qualitative and quantitative results of CLT before extubation and returning to the ward between two groups （ all P 〈 0. 05 ） , indicating that CLT results were related to age. In group B, there was no significant difference in ventilator- carried time between children with positive result and children with negative result of quantitative and qualitative CLT （ P 〉 0. 05）. Conclusion CLT result is related to age, the different CLT results had no significant influence on the ventilatorcarried time in children less than 24 months of age, so it was not a necessary condition for extubation and it has little value in guiding extubation for children with mild disease.