在体外循环期间肺高压患儿采用不同通气模式对呼吸功能的影响

Effects of different modes of mechanical ventilation on lung function during extracorporeal circulation for children with pulmonary hypertension

目的 :观察小儿先心肺高压在心内直视手术麻醉期间 ,不同通气模式对呼吸功能的影响。方法 :将 2 4例中度肺高压 (M组 )和 2 4例重度肺高压 (S组 )的先心病患儿随机各分为三组 :M1 、S1 组为PCV通气组 ;M2 、S2 组为PCV +PEEP(2cmH2 O)通气组 ;M3、S3组为PCV +PEEP(4cmH2 O)通气组。测定各组各时点的呼吸系统总顺应性 (Crs)及肺表面活性物质 (PS)生化指标。结果 :与诱导插管后、体外循环 (CPB)转流前比较 ,M1 、M2 组以及S1 、S2 组体外循环转流后和术毕的Crs值有显著下降 (P <0 0 1 ) ,而M3和S3组前后比较则Crs值无明显改变 ;M1 、M2 组以及S1 、S2 组体外循环转流后和术毕的SatPC/TP、SatPC/TPL比值下降显著 (M1 、S1 组 ,P <0 0 1 ;M2 、S2 组 ,P <0 0 5) ,而M3和S3组SatPC/TP、SatPC/TPL比值无明显改变。结论 :采用 4cmH2

Objective:To investigate the effects of different modes of ventilation on lung function during extracorporeal circulation for children with pulmonary hypertension(PH).Methods:Twenty-four patients with moderate PH(group M) and twenty-four patients with severe PH(group S)were further divided randomly into 3 groups Group M\-1\,S\-1 is part of PCV:M\-2,S\-2 is part of PCV+PEEP(2cmH\-2O);M\-3\,S\-3 is part of PCV+PEEP (4cmH\-2O);T\-1,T\-2,T\-3 of groups of respiratory system compliance(Crs) and biochemical criterion of pulmoranl surfactant were measured.Results:(1)Crs decreased significantly at T\-2 and T\-3 as compared with that at T\-0 and T\-1 in group M\-l/S\-1 and M\-2/S\-2 but in group M\-3/S\-3 there was no significant difference in Crs between T\-0,T\-1 and T\-\{2～3\}.(2)Sat PC/TPL and Sat PC/TP decreased significantly after CPB (T\-2,T\-3) in group M\-1/S\-1 and M\-2/S\-2 but in group M\-3/S\-3 there was no significant difference in Sat PC/TP and Sat PC/TPL between T\-\{0～1\} and T\-\{2～3\}.Conclusions:PEEP 4 cmH\-2O can effectively prevent postoperative lung function from worsening.