体外循环对儿童术后肺功能的影响

Effect of extracorporeal circulation on pulmonary function after surgery in children

目的研究体外循环(ECC)对术后儿童肺功能的影响,并观察这些变化和时间的关系。方法择期行先天性心脏病矫治术的患儿36例,根据是否应用ECC分为两组:ECC组(A组,n=18)和经胸小切口封堵组(B组,n=18)。分别测定气管插管后5 min、气管插管后15 min、开胸后5 min、术毕、术后2 h、脱机前的胸肺顺应性(CL)、气道平均压(Pmean)、气道阻力(Raw)及脱机时间。结果 ECC术后患者的CL明显下降,而封堵手术对CL影响不大;ECC组于开胸后CL明显降低(P<0.05),于术毕降至最低水平,后逐渐恢复,到拔管时基本达气管插管后水平;ECC组气道阻力、气道平均压于开胸后增加(P<0.05),至脱机前恢复正常水平。ECC组呼吸机支持时间明显长于封堵组。结论 ECC对先天性心脏病患儿术后肺功能有明显影响,引起呼吸动力学的改变,因此应注意术中对肺功能的保护。

OBJECTIVE To observe the effect of extracorporeal circulation（ECC） on pulmonary function after sternotomy in children.METHODS 36 children received heart surgeries were divided into two groups（ECC group and non-ECC group,18 cases in each group） according to whether ECC was used.Measurements of thoracic lung compliance（CL）,airway resistance（Raw） and mean airway pressure（Pmean） were performed at 5 min,15 min after intubation,5 min after sternotomy,the end of surgery,2 h after surgery and before extubation.RESULTS The CL was significantly decreased after ECC.In the ECC group,the CL decreased,the Raw and Pmean elevated evidently at 5 min after sternotomy（P0.05）,and theses there parameters tended to be normal before extubation.The ventilator support time of patients in the ECC group was longer than in the non-ECC group.CONCLUSION ECC has a significantly impairment on pulmonary function in children with congenital heart disease and cause the changes of patients＇ pneodynamics.So during the heart surgery with ECC for children,the pulmonary function of patients should be protected.