心外科术后机械通气治疗效果观察

Effect observation of mechanical ventilation treatment after cardiac surgery

目的总结心外科术后机械通气的经验和教训,提高患者生存率。方法选择2009年1月~2012年1月在解放军海军总医院心外科接受心脏手术的患者510例。患者术后于ICU病房常规使用呼吸机辅助通气,成人呼吸模式多采用容量控制（CMV）,潮气量按8~12 mL/kg体重计算,呼吸频率为12~18次/min,初始氧浓度为40%,吸呼比1∶1.5~2.0;儿童呼吸模式采用同步间歇指令通气（SIMV）,潮气量按10 mL/kg体重计算,呼吸频率为18~26次/min,氧浓度40%,吸呼比1∶1.5~2.0;其他参数根据每例患者的具体情况进行设置。待患者完全清醒、血气值稳定后,便可撤机、拔管。结果 510例手术患者,上机时间为2~192 h,其中,先天性心脏病患者355例,平均上机时间（6.0±3.6）h,风湿性心脏病患者122例,平均上机时间为（11.0±8.3）h。结论心外科手术呼吸机使用的经验和教训,对于今后更好的掌握一般心外科手术后呼吸机的使用规律、减少并发症的发生、提高手术存活率具有重要意义。

Objective To summarize the experience and lessons of mechanical ventilation after cardiac surgery, in or- der to increase the survival rate among patients. Methods 510 cases of patients who had cardiac operations in Cardiac Surgery Department of Naval General Hospital of PLA from January 2009 to January 2012 were chosen. After surgery, the patients were routinely assisted with ventilation by ventilators in ICU. For adult patients, the generally employed mode of ventilation was the controlled mechanical ventilation （CMV） and tidal volume was calculated according to 8- 12 mL/kg by weights, with respiratory rate of 12-18 times/rain, initial oxygen concentration of 40% and inspiratory to expiratory ratio （I：E） of 1：1.5-2.0. For pediatric patients, SIMV was employed as ventilation mode and tidal volume was calculated according to 10 mL/kg by weights, with respiratory rate of 18-26 times/min, oxygen concentration of 40% and I：E of 1：1.5-2.0. While, other parameters were set based on individual conditions of the patients. Weaning and extubation were conducted when the patients became fully conscious with stable blood gas values. Results The ventilation time for 510 patients varied from 2 to 192 h, including 355 cases of congenital heart disease with average ventilation time of （6.0±3.6） h and 122 cases of rheumatic heart disease with average ventilation time of （11.0±8.3） h. Conclusion The experience and lessons of the ventilator utilization in cardiac surgery are significant in understanding more about the principles of ventilator exploitation after cardiac surgery, decreasing the occurrence of complications and increasing the survival rate of surgery.