小儿体外循环术后再次气管插管血气指征探讨

Study on Blood Gas Analysis Criteria of Re-intubation After Surgical Operations on Children With Cardiopulmonary Bypass

目的探讨小儿先天性心脏病体外循环下心内直视手术后再次气管插管的血气指标。方法非选择性调查PICU撤机、拔管病例的血气分析与转归,按撤机拔管转归和PaCO2、PaO2/FiO2分组熏比较各组PaO2、PaCO2、PaO2/FiO2及成败比率。结果连续调查了62例撤机、拔管前后及拔管后1h血气分析结果,19例失败需再次气管插管。再插管组:撤机、拔管前后比,PaCO2指标,P<0.05,而PaO2、PaO2/FiO2指标均P<0.01;拔管后1hPaCO2>45mmHg与<45mmHg组再次气管插管率比,P<0.01。PaO2/FiO2不同水平再插管率比:撤机前>200mmHg与<200mmHg,P<0.01,<200mmHg者再插管率100%;拔管后1h各组再插管率比,P<0.01,<250mmHg者再插管率为100%。结论拔管后1hPaCO2>45mmHg、PaO2/FiO2<250mmHg、吸氧下PaO2和PaO2/FiO2显著性下降者,需再次气管插管呼吸机治疗。PaO2、PaCO2、PH正常,aO2/FiO2>200mmHg时撤机、拔管成功可能性大,可避免再次插管。

Objective To explore the blood gas analysis criteria of re-intubation after the operation of children with cardiopulmonary bypass. Methods The results of the blood gas analysis of patients withdrawed and extubated in PICU and the prognosis of them,were investigated randomly grouped according to the prognosis of withdrawal and extubation and comparing the value of PaO2 ,PaCO2,PaO2/FiO2mmHg between each group ﹠the ratio of success and failure. Results Continuously recording the results of blood gas analyses of 62 samples before withdrawal and extubation and 1 hour later. 43 examples of them were success and 19 failure samples have to be re-intubated. In failure group: comparing PaCO2 value( P<0.05), PaO2 and PaO2/ FiO2 value(P<0.01)after and before withdraws and extubation. After extubation comparing group PaCO2 >45 with<45,the ratio was significant (P<0.01).The re-intubation(failure) ratio of PaO2/ FiO2 at different level :>200 with<200 before withdraws P<0.01,re-intubation ratio of the patient below 200 was 100%. Comparing the re-intubation ratio of each group showed that an hour after extubation was significant difference( P<0.01), the re-intubation rate was 100% while the PaO2/FiO2 ratio was below 250. Conclusions The patients whose PaCO2>45,PaO2/FiO2<250 and PaO2 decresaed ( when inhaling oxygen ) notably need the re-intubation and the respirator therapy after extubation. PaO2, PaCO2 and pH are normal,PaO2/FiO2>200; The withdrawal of respriator and extubation will be succeed ,none need the re-intubation and the respirator therapy.