儿童先天性心脏病术后脱机参数的研究

Study on Weaning Parameters after Operation for Children with Congenital Heart Disease

目的:研究先天性心脏病(先心病)患儿术后机械通气期间相关指标的变化,探讨影响脱机成功率的有关呼吸力学指标、血气相关指标及其他相关因素(体力体能、生命体征等),并研究儿童先心病术后患儿脱机的适宜流程,指导术后早期撤机。方法:收集2019年9月-2021年7月桂林市人民医院收治的60例先心病患儿的临床与实验室资料,包括年龄、性别、体重、先心病类型、体外循环时间、肺部异常情况等。根据呼吸机撤离失败与否分为撤机失败组(B组)和撤机成功组(A组)。结果:两组年龄、体重比较,差异均有统计学意义(P<0.01);且B组年龄<3个月及3~6个月、体重<5 kg比例均高于A组(P<0.05)。两组动脉血氧分压比较,差异无统计学意义(P>0.05);两组体外循环时间、呼吸机使用时间比较,差异均有统计学意义(P<0.05);但两组撤机后喉头水肿、肺部感染情况比较,差异均无统计学意义(P>0.05)。A组动脉血二氧化碳分压低于B组,机械通气时间短于B组,差异均有统计学意义(P<0.05)。A组肺顺应性、最大吸气压、综合脱机参数(CROP)均高于B组,呼吸频率低于B组,差异均有统计学意义(P<0.05)。结论:年龄、体重、体外循环时间、呼吸机使用时间、动脉血二氧化碳分压、机械通气时间、呼吸指标会影响儿童先天性心脏病术后脱机,应加强对患儿术后脱机参数的监测,以提高脱机成功率。

Objective:To study the changes of related indexes during mechanical ventilation in children with congenital heart disease,exploring the respiratory mechanics indexes,blood gas indexes and other related factors(physical strength,vital signs,etc.)affecting the success rate of weaning,and to study the appropriate process of weaning for children with congenital heart disease after operation,so as to guide the early weaning after operation.Method:The clinical and laboratory data of 60 children with congenital heart disease who treated in Guilin People’s Hospital from September 2019 to July 2021 were collected,including age,gender,body weight,type of congenital heart disease,cardiopulmonary bypass time,pulmonary abnormality.According to the weaning outcomes,they were divided into the failure group(group B)and the success group(group A).Result:There were significant differences in age and body weight between two groups(P<0.01);the proportion of age<3 months and 3-6 months,body weight<5 kg in group B were higher than those in group A(P<0.05).There was no significant difference in arterial partial pressure of oxygen between two groups(P>0.05);there were significant differences in the time of cardiopulmonary bypass and ventilator use between two groups(P<0.05).However,there were no significant differences in laryngeal edema and pulmonary infection between two groups after weaning(P>0.05).The arterial partial pressure of carbon dioxide in group A was lower than that in group B,and the mechanical ventilation time was shorter than that in group B,and the differences were statistically significant(P<0.05).The pulmonary compliance,maximum suction pressure and respiratory multiple indexes(CROP)in group A were higher than those in group B,and the respiratory rate was lower than that in group B,the differences were statistically significant(P<0.05).Conclusion:Age,body weight,extracorporeal circulation time,ventilator use time,arterial partial pressure of blood carbon dioxide,mechanical ventilation time and respiratory indicators will affect weaning after surgery for children with congenital heart disease.Monitoring of weaning parameters after surgery should be strengthened to improve the success rate of weaning.