肺开放通气对体外循环术后急性肺损伤婴幼儿呼吸力学和血流动力学的影响

Effect of open lung ventilation on respiratory mechanics and haemodynamics in acute lung injury infants after cardiopumonary bypass

目的:探讨肺开放治疗对体外循环(cardiopulmonary bypass,CPB)术后急性肺损伤(acute lung injury,ALI)婴儿血流动力学和呼吸力学的影响。方法:随机选取2008年3月～2010年7月西京医院心血管外科接受心脏手术的64例ALI婴幼儿,分为无肺复张治疗组(非肺复张组):采用小潮气量通气模式进行呼吸辅助及治疗,肺复张治疗组(肺复张组):在小潮气量通气模式下,加用肺开放治疗(lung recruitment maneuver,LRM)。结果:在肺复张治疗后,呼吸力学和氧合都有显著的改善,肺复张组的PaO2[(284±19)mmHg]明显高于非肺复张组[(78±18)mmHg](P<0.01)。肺复张组的呼吸力学指标显著优于非肺复张组,血流动力学指标无显著性差异。结论:LRM可以大大改善婴儿CPB术后ALI的氧合及呼吸力学。

AIM： To investigate the effects of open lung ventilation on the haemodynamics and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass（CPB）.METHODS： Sixty-four infants with ALI undergoing open-heart surgery were randomized into Group A of no-lung recruitment maneuver（N-LRM）,with only low tidal volume,and Group B of lung recruitment maneuver（LRM）,with low tidal volume and lung recruitment maneuver remedy.RESULTS： The oxygenation was remarkably improved after LRM in group B.PaO2 in Group B was significantly higher than that in group A [（284±19） mmHg vs.（78±18） mmHg,P 0.01] and the respiratory mechanics in group B was superior to those in group A.No significant difference was observed in the haemodynamics between the two groups.CONCLUSION： LRM improves the oxygenation and the respiratory mechanics but has no obvious side effect on haemodynamics in infants with ALI after cardiopulmonary bypass.