室间隔缺损伴肺动脉高压患儿围术期肺功能变化

PERIOPERATIVE CHANGES OF RESPIRATORY FUNCTION IN CHILDREN WITH VENTRICULAR SEPTAL DEFECTS ASSOCIATED WITH PULMONARY HYPERTENSION

目的检测室间隔缺损伴肺动脉高压（ＶＳＤ＋ＰＨ）患儿围术期呼吸力学及呼吸指数变化，探讨其肺功能的变化规律及可能的影响因素。方法以ＮａｖｉｇａｔｏｒＧＭ２５０旁气流型肺功能仪测定术前、术后即刻、术后４ｈ肺动态顺应性（Ｃｄｙｎ），在同一时点检测吸入氧浓度（ＦｉＯ２）并查血气得ＰａＯ２、ＰａＣＯ２值，计算呼吸指数（ＲＩ）。结果术前ＶＳＤ＋ＰＨ组Ｃｄｙｎ明显低于ＶＳＤ组（Ｐ＜０．０１），ＲＩ明显高于ＶＳＤ组（Ｐ＜０．０１），术后两组患儿Ｃｄｙｎ均较术前明显下降（Ｐ＜０．０１），ＲＩ明显增高（Ｐ＜０．０１），ＶＳＤ＋ＰＨ组增高幅度更为明显（Ｐ＜０．０５）。结论伴有肺高压的室间隔缺损患儿肺功能较差。经体外循环心内直视术后其肺功能下降尤为明显，且在术后短期内不能迅速改善。

URPOSE To identify perioperative changes and the possible factors affecting respiratory function in children suffering from ventricular septal defects and with pulmonary hypertension (VSD+PH).METHODS Forty patients were studied, 20 of whom were associated with PH (Pp/Ps≥45%) and 20 without PH (Pp/Ps<45%). The pulmonary dynamic compliance (Cdyn) was determined respectively before, immediately after and 4 hours after operation. At the same time the respiratory index (RI) was calculated from Pa O2, Pa CO2 and inspiratory oxygen concentration (Fi O2).RESULTS Preoperative Cdyn was lower and RI higher in the children with PH compared with those without PH. After cardiac surgery, Cdyn was lower and RI higher in both groups, especially in the VSD+PH group.CONCLUSIONS Respiratory function of the VSD+PH group was decreased as compared with those of the simple VSD group before operation. After open heart surgery, respiratory function decreased far than in the VSD+PH group and was not improved in the immediate postoperative period.