婴幼儿先心术后的呼吸道管理

Postoperative respiratory management of infants with congenital heart diseases

目的 探讨婴幼儿先心术后呼吸道管理。方法 收治婴幼儿先心术后病例 96例 ,平均年龄 16± 7 8个月 ,平均体重 10± 5 2千克。其中 93例接受Ⅰ期根治术 ,3例接受姑息性手术。术后呼吸机通气采用定容或西门子 30 0的压力调节定容模式 (PRVC)。部分病例术后接受吸入一氧化氮 (NO)和外源性肺表面活性物质 (PS)治疗。结果 术后呼吸机辅助时间3 5～ 84小时 ,平均 8 6小时。ICU期间呼吸道感染率 8 2 % (8/ 96 ) ,肺不张发生率 7 2 % (7/ 96 )。术后近期死亡率 6 2 % (6 /96 ) ,死亡原因低心排综合征 3例、严重感染 2例、出血 1例。结论 婴幼儿先心术后呼吸道管理有其自身特点 ,抓住这些特点就可以使手术的死亡率、并发症的发生率进一步下降 ,从而获满意的疗效。

Objective To discuss the postoperative respiratory management of infants with congenital heart diseases(CHD).Methods Our ICU received 96 post-cardiac operation patients aged less than 3 years old.Mean age was 16±7 8 months,mean body weight was 10±5 2 kg.Corrective operation was done in 93 cases while the other 3 cases received palliative procedure.Postoperative ventilating modes included volume control(VC),pressure regulated volume control (PRVC).Some cases also received inhaled nitric oxide and exogenous pulmonary surfactant.Results Ventilating time varied from 3.5 hours to 84 hours,with the mean time 8.6 hours.During the ICU stage,the respiratory infection rate was 8.2%(8/96).Pulmonary atelectasis was found in 7.2%(7/96) patients.Postoperative early mortality was 6.2%(/96) attributed to low cardiac output in 3,severe infection in 2 and bleeding in 1.Conclusions The infants with congenital heart diseases have their own characters in postoperative respiratory management.Manipulating according to these characters will lead to a more satisfied outcome. [