二氧化碳充溢降低小儿先天性心脏病手术中气体栓塞的疗效

Efficacy of carbon dioxide in reducing gas embolism in pediatric patients with congenital heart disease

目的改良二氧化碳(CO_2)充溢技术在小儿先天性心脏病手术中防止气体栓塞的安全性和有效性。方法以我院2014年1月~2015年6月心外科的90例先天性心脏病患儿为研究对象,并根据随机数字排列表分为3组(每组30例)。CO_210 L/min组(CO_2流量为10 L/min),CO_25 L/min组(CO_2流量为5 L/min),对照组不采用CO_2充溢法。3组均采用头低位、心脏底部按摩等机械性手法进行排气。对3组术中的排气效果、血气分析中的血CO_2分压(Pa CO_2)、手术时间、主动脉阻断时间以及体外循环时间进行比较。结果本次研究的所有患者手术均获得了成功,3组患儿的手术时间、主动脉阻断时间以及体外循环之间比较差异均无统计学意义;主动脉开放10 min时,CO_210 L/min组(16±3)个/min和CO_25 L/min组(23±4)个/min的脑膜中动脉气泡数量均少于对照组(50±7)个/min,CO_210 L/min组的气泡数目也少于CO_25 L/min组,差异具有统计学意义(均P<0.05);停止体外循环后,3组脑膜中动脉气泡的数量差异无统计学意义;主动脉开放时以及停止体外循环时,3组的Pa CO_2的差异均无统计学意义。结论改良后的CO_2充溢技术用于小儿先天性心脏病手术可明显减少气体栓子的数量,气流较大效果更好,且安全性较好。

AIM To study the safety and efficacy of improved carbon dioxide （CO2） technique in the prevention of gas embolism in children with congenital heart disease （CHD）. METHODS Ninety patients with CHD in our hospital from January 2014 to June 2015 were selected for this study and randomly divided into three groups （n=30 each）： group CO2 10 L/min （CO2 flow 10 L/min）, CO2 5 L/min group （CO2 flow 5 L/min） and control group （with no carbon dioxide）. Head low, heart bottom massage and other mechanical methods were used for gas exhaust in all three groups. The effects of gas exhaust, blood gas analysis, blood pressure （PaCO2）, surgical time, aortic clamping time and cardiopulmonary bypass time were compared among the three groups. RESULTS Surgical procedure was successfully performed in all patients. No statistically significant difference was found in surgical time, aortic blocking and cardiopulmonary bypass time among the three groups. When the aorta was opened for 10 min, the number of bubbles in the meningeal artery in CO2 10 L/min group and CO2 5 L/min group was less than that in the control group [（16±3） times/min and （23±4） times/min vs.（50±7） times/min] and the number of bubbles in the CO2 10 L/min group was lower than in the CO2 5 L/min group, with a significant difference （all P〈0.05）. After stopping cardiopulmonary bypass, no statistically significant difference in the number of bubbles in the meningeal artery was found among the three groups. After opening the aorta and stopping the cardiopulmonary bypass, there was no statistically significant difference in PaCO2 among the three groups. CONCLUSION The improved CO2 technique is efficacious and safe for pediatric patients with CHD because it can significantly reduce the number of gas emboli and increase the air flow.