不同吸入氧浓度对法洛四联症患儿在麻醉中及术后肺功能的影响

Effects of Different Inhaled Oxygen Concentrations on the Pulmonary Function of Children with Tetralogy of Fallot during and after Anesthesia

目的研究不同氧浓度对法洛四联症(TOF)患儿在麻醉中及术后肺功能的影响。方法选取该院2018年6月—2021年6月行初次TOF矫治手术的患儿84例作为研究对象,经数字随机表法分为对照组和观察组,各42例。对照组吸入纯氧,观察组吸入60%浓度的氧,记录两组心肺分流术(CPB)中升主动脉阻断时间、体外循环时间,记录手术时间、术后气管带管时间、ICU停留时间和动脉氧分压(PaO_(2)),计算两组肺泡-动脉氧分压差(PA-aO_(2))、呼吸指数(RI)和氧合指数(OI),并对上述各指标进行比较分析,对比两组麻醉后的不良反应。结果两组在CPB中升主动脉阻断时间、体外循环时间、手术时间方面差异无统计学意义(P>0.05)。观察组术后气管带管和ICU停留时间分别为(29.37±7.02)、(75.42±11.37)h,均少于对照组的(36.45±8.64)、(86.03±15.61)h,差异有统计学意义(t=4.122、3.561,P<0.05)。诱导前,两组PA-aO_(2)、PaO_(2)、RI、OI相比较,差异无统计学意义(P>0.05);CPB后6 h均较诱导前变化,且观察组PA-aO_(2)、RI明显低于对照组,PaO_(2)、OI明显高于对照组,差异有统计学意义(P<0.05)。观察组不良反应率为11.90%,对照组不良反应率为14.29%,两组比较差异无统计学意义(χ^(2)=0.105,P>0.05)。结论TOF患儿在全麻下接受手术治疗时,空氧混合吸入氧浓度60%,不但能够避免高浓度氧对患儿肺交换功能的影响,而且不会导致患儿出现低氧血症,是一种安全、有效的全麻患儿给氧方式,有利于患儿术后肺功能的恢复。

Objective To study the effects of different oxygen concentrations on the pulmonary function of children with tetralogy of Fallot(TOF)during anesthesia and after surgery.Methods A total of 84 children who underwent initial TOF correction surgery in the hospital from June 2018 to June 2021 were selected as the research objects,and they were divided into the control group and the observation group by the number random table method,with 42 cases in each group.The control group inhaled pure oxygen,and the observation group inhaled 60%oxygen.The ascending aorta occlusion time and cardiopulmonary bypass time in the two groups of cardiopulmonary bypass(CPB)were recorded.The operation time,postoperative tracheal intubation time,ICU stay time and arterial partial pressure of oxygen(PaO_(2))were recorded.Calculated the alveolar-arterial partial pressure difference(PA-aO_(2)),respiratory index(RI)and oxygenation index(OI)of the two groups.The above indicators were compared and analyzed,and the adverse reactions of the two groups after anesthesia were compared.Results There was no statistically significant difference between the two groups in ascending aorta occlusion time,extracorporeal circulation time,and operation time in CPB(P>0.05).The postoperative tracheal tube and ICU stay time in the observation group was(29.37±7.02)h and(75.42±11.37)h,respectively,which were less than those of the control group(36.45±8.64)h and(86.03±15.61)h,the difference was statistically significant(t=4.122,3.561,P<0.05).Before induction,there was no statistically significant difference between the two groups of PA-aO_(2),PaO_(2),RI,OI(P>0.05);6 h after CPB,were changed compared with those before induction;the PA-aO_(2) and RI of the observation group were significantly lower than those of the control group,and the PaO_(2) and OI were significantly higher than those of the control group,the difference was statistically significant(P<0.05).The adverse reaction rate in the observation group was 11.90%,and the adverse reaction rate in the control group was 14.29%,there was no statistically significant difference between the two groups(χ^(2)=0.105,P>0.05).Conclusion When children with TOF undergo surgical treatment under general anesthesia,the air-oxygen mixed inhaled oxygen concentration was 60%,which can not only avoid the effect of high-concentration oxygen on the lung exchange function of the children,but also will not cause the children to develop hypoxemia.It is a safe and effective way to give oxygen to children under general anesthesia,which is conducive to the recovery of lung function in children after surgery.