小儿心脏术后急性呼吸窘迫综合征的预防及治疗

The Preventive and Treatment Strategy in Pediatric Patients with Acute Respiratory Distress Syndrome after Open Heart Surgery

为探讨小儿心脏术后急性呼吸窘迫综合征 (ARDS)的临床发病特点及治疗对策 ,对 2 3例 ARDS患儿 (包括早期发病 8例、迟发 15例 )采用 :1限制吸气峰压≤ 35 cm H2 O(3.43k Pa) ;2早期应用呼气末正压 (PEEP) 8～ 12cm H2 O(0 .78～ 1.18k Pa) ;3反复性侧卧体位等措施。结果 2 3例中 1例 (1/2 3)继发感染、急性肾功能衰竭死亡 ;并发气胸 2例 (2 /2 3) ;严重肺不张 3例 (3/2 3) ;痰培养阳性 5例 (5 /2 3)。结果显示 :对 ARDS高危患儿应慎重选择早期拔管指征 ;对诊断明确者应用低容量限压通气配合体位变换可减少并发症。

To sum up the clinical course and treatment strategy of pediatric patients with acute respiratory, distress syndrome (ARDS) after open heart surgery, we studied 23 pediatric ARDS patients including early episode in 8 cases and late episode in 15 cases. The maneuvers we performed were as follow:①Applying low peak inspiratory pressure ≤35 cm H 2O; ②Using PEEP 8～12 cm H 2O in the early period; ③Repeated lateral positioning.Results:1 case (1/23) died because of infection and acute renal failure, 2 cases (2/23) complicated with pneumothorax, 3 cases (3/23) with serious atelectasis and 5 cases (5/23) with positive sputum culture. Conclusion : We consider that choosing early extubation with discretion and applying low volume pressure limited ventilation combined with repeated lateral positioning can lower the Complications and mortality in the treatment of ARDS.