摘要
目的 探讨气管滴入外源性肺表面活性物质（PS）治疗婴幼儿心肺转流下心脏术后急性肺损伤（ ALI）效果.方法 选同一时期于本院行室缺修补术且术后出现急性肺损伤23例患儿为研究对象,术前均无需吸氧和机械通气.10例在术后机械通气同时予气管滴入PS10治疗为治疗组,以随机选取同时期心肺转流术后急性肺损伤未予PS气管内滴入治疗婴幼儿13例为对照组,所有患儿每6小时监测血气1次并记录呼吸机参数,然后对两组患儿术前一般资料（体重、年龄、性别构成、室缺直径及CPB时间）、术后相关临床监测指标（氧合指数、平均气道压、pH值及二氧化碳分压）和临床预后进行比较分析.结果 治疗组患婴气管滴入PS后24 h,氧合指数上升至285±16.51,平均气道压降至（10.4±3.37）cm H2O（1 cm H2O =0.098 kPa）,而在术后24 h对照组相氧合指数及平均气道压分别为133±19.62,（13.8±2.55） cm H2O,两组比较差异显著（P＜0.05）,而pH值和二氧化碳分压无显著差异.治疗组机械通气时间（17.43±9.12）h明显短于对照组（30.97±14.85） h（P＜0.05）,监护室停留时间（3.90±1.34）d也明显短于对照组（6.18±1.90） d（P ＜0.05）,对照组病死两例,治疗组无死亡.结论 PS气管内滴入对婴幼儿心肺转流术后急性肺损伤的氧合改善有令人满意疗效,减少机械通气时间及监护室停留时间,改善预后.
Objective Acute lung injury is a severe complication after cardiac surgery performed with cardiopulmonary bypass in infant patients. Pulmonary surfactant has been successfully used in treating neonatal respiratory distress syndrome for many years.This study focused on exploring the clinical efficacy of exogenous pulmonary surfactant in treating infant patients with acute lung injury after cardiac surgery with the use of extracorporeal circulation.Method Twenty-three infants with ventricular septal defect （VSD） were enrolled in the study.None of the patients needed oxygen treatment nor ventilation before heart surgery.VSD repair operation was done under cardiopulmonary bypass,and acute lung injury was found postoperatively.Ten infant patients in the treatment group were given pulmonary surfactant by tracheal instillation during mechanical ventilating postoperatively.Thirteen patients in control group were randomly selected in the same period in hospital, and acute lung injury was diagnosed without pulmonary surfactant treatment after cardiopulmonary bypass. Blood samples were obtained from all the patients,and blood gas analysis was performed every 6 hours. Demographics （body weigh, age, gender, VSD diameter ） and clinical characteristics （ CPB time,oxygenation index,mean airway pressure,pH and PCO2 ） of all the patients were collected,and statistical analysis was done to compare the data between treatment and control group.Result In the first 24 hours after heart surgery,compared with the control group,a more increased oxygenation index （from 89.36 ± 12.69 to 285 ± 16.51 ） was observed in treatment group,and it was from 93.71 ±11.82 to 133 ± 19.62 in the control group.There was a significant difference in oxygenation index between the two groups （P 〈 0.05 ）.At the same time,the MAP （from 17.5 ± 3.18 to 10.4 ± 3.37 ） of the patients in comparison with the control group （ from 18.2 ± 2.63 to 13.8 ± 2.55 ）,a more significantly decreased MAP was observed in the treatment group （P 〈 0.05）.There was no significant difference in pH and PCO2between the two groups.The ventilation time in cardiac care unit was shorter in treatment group （ 17.43 ± 9.12）h compared with the control group [ （30.97 ± 14.85） h,P 〈0.05].ICU stay time of treatment group （3.90 ± 1.34）d was shorter than that of control group [ （6.18 ± 1.90） d,P 〈0.05].Two infants of the control group died,but none in treatment group died. Conclusion In this study,a satisfactory curative effect was observed for the treatment of acute lung injury with PS intratracheal instillation after heart surgery under cardiopulmonary bypass in infant patients. It can reduce the duration of mechanical ventilation and cardiac care unit stay and improve prognosis.In addition,this study was a pilot study and the limited sample size was probably the cause of insufficient statistical power.Further study of larger scale is needed.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第3期193-196,共4页
Chinese Journal of Pediatrics
关键词
呼吸障碍
肺损伤
肺表面活性物质
心肺转流术
Respiration disorders
Pulmonary injury
Pulmonary surfactant-associated proteins
Cardiopulmonary bypass
