左向右分流性先天性心脏病患儿围术期肺功能变化

Perioperative changes of respiratory function in children with congenital cardiac defect of left to right shunt

目的 检测动脉导管未闭 (PDA)、室间隔缺损 (VSD)患儿围术期呼吸力学及血气指标变化 ,探讨围术期肺功能变化及其影响因素。方法 以 2 0例PDA患儿 (非体外循环组 )及 2 0例VSD患儿 (体外循环组 )为研究对象 ,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 体外循环组术后Cdyn较术前明显降低 ,RI较术前明显增高 ,非体外循环组手术前后Cdyn、RI无明显变化。 结论 经体外循环心内直视术后患儿肺功能下降明显 。

Objective To observe the perioperative changes and the possible affecting factors of respiratory function in children with congenital cardiac defects of left to right shunt. Methods 20 children with ventricular septal defect (VSD) (extacorporal circulation group) and 20 with patent ductus arteries (PDA) (non extracorporal circulation group) were studied. The dynamic pulmonary compliance (Cdyn) was determined before, immediately after and 4 hours after the operation, respectively. At the same time the respiratory index (RI) was calculated from PaO 2, PaCO 2 and inspiratory oxygen concentration(FiO 2).Results In cardiopulmonary bypass group, Cdyn was decreased and RI increased significantly after operation compared with that before operation. No significant changes were found in non extacorporal circulation group. Conclusion Respiratory function decreased significantly after extacorporal circulation. It might not be improved in the immediate postoperative period.(Shanghai Med J, 2000,23∶454 455.)