CAJ | 학술논문

目的：评价肺复张（ RM）对婴幼儿先天性心脏病围手术期呼吸道管理中的应用价值。方法：选择2011年10月～2012年10月我科收治的60例呼吸机辅助机械通气患儿给予肺复张，采用正压双水平复张（ PEEP）结合恒压通气方式加以控制性肺膨胀（ SI），实现肺泡复张，观察肺复张前后患儿的呼吸力学和血气分析及血流动力学等指标变化。结果：所有患儿肺复张治疗后酸碱度（ pH）、氧分压（ PaO2）、吸氧浓度（ FiO2）、肺静态顺应值（Cst）均呈逐步上升趋势，气道峰值（PIP）呈下降状态，与治疗前比较有统计学意义（P＜0．05）；但复张后12，24，48 h各时间点比较无统计学意义（P＞0．05）；肺复张后平均动脉压（MAP）、心指数（CI）、心率（HR）、中心静脉压（CVP）分别呈现不同趋势的降低和升高，与复张前比较差异有统计学意义（P＜0．01），复张时与复张2，5 min比较有统计学意义（P＜0．05）。结论：对复杂先天性心脏病术后患儿呼吸道疾病早期应用肺复张可以有效促进塌陷、萎缩性肺泡复张，改善肺部氧合，同时增加肺容积并减少并发症的发生。
목적：평개폐복장（ RM）대영유인선천성심장병위수술기호흡도관리중적응용개치。방법：선택2011년10월～2012년10월아과수치적60례호흡궤보조궤계통기환인급여폐복장，채용정압쌍수평복장（ PEEP）결합항압통기방식가이공제성폐팽창（ SI），실현폐포복장，관찰폐복장전후환인적호흡역학화혈기분석급혈류동역학등지표변화。결과：소유환인폐복장치료후산감도（ pH）、양분압（ PaO2）、흡양농도（ FiO2）、폐정태순응치（Cst）균정축보상승추세，기도봉치（PIP）정하강상태，여치료전비교유통계학의의（P＜0．05）；단복장후12，24，48 h각시간점비교무통계학의의（P＞0．05）；폐복장후평균동맥압（MAP）、심지수（CI）、심솔（HR）、중심정맥압（CVP）분별정현불동추세적강저화승고，여복장전비교차이유통계학의의（P＜0．01），복장시여복장2，5 min비교유통계학의의（P＜0．05）。결론：대복잡선천성심장병술후환인호흡도질병조기응용폐복장가이유효촉진탑함、위축성폐포복장，개선폐부양합，동시증가폐용적병감소병발증적발생。
To evaluate the recruitment maneuver ( RM) for infants and young children congenital heart disease of perioperative respiratory tract management application value and follow the curative effect observation of the care .Methods:60 cases breathing machine auxiliary mechanical ventilation were given recruitment maneuvers,used positive pressure double level after a combined with constant pressure (PEEP) ventilation way to control lung ex-pansion ( SI) ,the realization of alveolar abdominal protracted war to strengthen the use and management of ventilator ,trachea insertion nursing and postoper-ative rehabilitation care,observe the patient′s vital signs before and after,recruitment maneuvers,oxygenation index (PaO2/FiO2),respiratory mechanics and hemodynamic changes such as indicators.Results:All children with recruitment maneuvers pH after treatment,PaO2,FiO2,Cst all have been gradually rising trend,PIP falling state,compared with before treatment (P<0.05).Protracted war but abdomen 12 h,24 h,48 h each time point compared with no statistical significance (P>0.05).Lung after protracted war MAP,CI,HR,CVP presents different trends of lower and higher respectively,compared with before the abdomen had significant difference (P<0.05),abdomen compared with abdominal 2 min,5 min was statistically significant (P<0.05).Conclu-sion:The application of complex congenital heart disease in children with respiratory diseases postoperative early lung after card can effectively promote the collapse,atrophic alveolar abdomen,improve pulmonary oxygenation,at the same time increase the lung volume and reduce complications.