体外循环心内直视术后呼吸衰竭的处理

Management of Respiratory Failure after Cardiopulmonary Bypass

呼吸功能不全是体外循环心内直视术后严重并发症之一，与术前的心功能和体外循环时间密切相关，延长或及时应用呼吸机辅助通气是主要的治疗手段。本科自1987年1月至1994年12月体外循环术后因各种原因需再次气管插管或气管切开长时间辅助通气共20例，术前心功能Ⅲ级—Ⅳ级18例（90％），体外循环转流时间超过2小时者14例（70％）。主要处理包括：（1）合理使用呼吸机（应用指征：术后早期；呼哀伴明显低氧血症；心跳、呼吸骤停；严重低心排）；（2）呼吸机通气模式应用适宜的PEEP（5－10cmH2O）；（3）加强呼吸道管理；（4）应用大剂量激素和莨菪类药物等。经上述治疗，所有病人均顺利脱机，仅一人死于呼吸衰竭。

Respiratory failure is one of the severe critical complications after openheart operation under cardiopulmonary bypass (CPB). It is closely associated with preoperative heart function and the duration of CPB,prompt and prolonged application of mechanical ventilation is essential treatment. This article reports 2O cases that required re-intubation or tracheostomy for prolonged period of ventilator support due to various reasons after CPB in our department from January 1987 to December 1994. There were 18(90% ) cases with preoperative heart function of N - N grade, and 14(70% ) with duration of CPB longer than 2 hours.The main management included: 1. Utilizing ventilator properly,the indications including early period of postoperation, respiratory failure with severe anoxemia,pulmonary and cardiac sudden arrest, grave low cardiac output 12. Using an appropriate positive end-expiratory pressure (PEEP) around 5-10cmH2O; 3. Improving management of airway1 4- Administration of steroids and anisodamine in large doses. All of the patients were weaned from ventilator successfully with only one death caused by respiratory failure.