外源性表面活性物质对体外循环术后急性肺损伤婴幼儿脱机及呼吸力学的影响

Effects of curosurf on ventilation weaning and respiratory mechanics in infants with acute lung injury after cardiopulmonary bypass

目的探讨外源性肺表面活性物质(PS)对体外循环术后急性肺损伤(ALI)婴幼儿患者脱机及呼吸力学影响。方法体外循环术后患婴12例术后出现ALI和脱机困难,给予肺保护性通气策略及PS进行治疗,观察血气、呼吸力学变化及脱机情况。结果气管内给药后婴幼儿患者自主呼吸平稳,自主呼吸频率明显降低,自主呼吸潮气量明显增加,三凹征消失,胸骨凹陷减轻,PaCO2明显降低,气道峰压(PIP)由(36.18±10.25)cmH2O下降到(25.11±5.14)cmH2O,肺静态顺应性(Cstat)由治疗前的(1.49±0.65)mL·cmH2O-1·kg-1上升到治疗后6h的(1.95±0.50)mL·cmH2O-1·kg-1;气道阻力(Raw)由治疗前的(128.17±26.34)cmH2O·L-1·s-1下降到(78.56±18.22)cmH2O·L-1·s-1。12例婴幼儿患者用药后均撤机成功。结论肺保护性通气策略联合应用PS可明显改善心脏病婴幼儿患者术后呼吸力学指标,提高肺动态顺应性,降低气道阻力,减少患婴呼吸功耗,使呼吸机撤离容易。

Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury （ALI） after cardiopulmonary bypass （CPB）. Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study. Exogenous PS was used in the treatment via intra-tracheal administration. The changes of blood gas, respiratory mechanics and the conditions of ventilation weaning were observed. Results After intra-tracheal PS administration, spontaneous breath remained steady, spontaneous respiratory rate significantly decreased, and tidal volume of spontaneous breath increased significantly. Three concave sign disappeared and koilosternia was alleviated. PaCO2 value decreased significantly and peak inspiratory pressure （PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O（P〈0.01）. Static lung compliance（Cstat） increased from （ 1.49±0.65 ）mL·cm H2O^-1·kg^-1 before treatment to （ 1.95±0. 50）mL·cm H2O^-1·kg^-1 6 h after treatment （ P 〈 0. 01 ） ; and airway resistance （ Raw ） decreased from （128.17±26.34 ） cm H2O·L^-1·s^-1 before treatment to （78.56±18.22）cm H2O·L^-1·s^-1 6 h after treatment（P 〈 0.01 ）. All 12 infants weaned from ventilator successfully. Conclusion Combined with PS intra-tracheal treatment, lung protective ventilation strategy can significantly improve parameters of respiratory mechanics, increase dynamic lung compliance, decrease airway resistance, which can decrease the breathing effort of the infants and make it easy to wean from ventilator.