【摘要】 目的探讨"改良肺通气与肺保护"的呼吸管理方法在小儿微创心脏手术中的应用价值。方法接受微创先天性心脏病矫治术患儿60例,随机分成改良肺通气与肺保护组(A组)和高频通气组(B组),每组30例,采用单腔气管内插管全麻,整个手术过程A组采用减少潮气量、增加呼吸频率、调节吸呼比的改良双肺通气法来暴露术野,结合肺保护技术减少肺损伤;B组行常规高频通气配合完成手术。观察2种呼吸管理方法对手术、预后的影响。结果2组术野暴露满意,均无恶性心律失常、残余漏及肺水肿等并发症。A组与B组相比,前组术中血流动力学指标平稳,低氧血症、高碳酸血症发生率,术后肺部并发症、呼吸机辅助时间、ICU停留时间及术后住院时间均明显减少(P<0.05)。结论小儿微创心脏手术中采用"改良肺通气与肺保护"的呼吸管理方法,不仅能取得能良好术野暴露,满足手术要求,还能减少术后肺部并发症,缩短呼吸机辅助时间和术后住院时间。更多还原

【Abstract】 Objective To investigate the application value of improved management of breathe and lung protection in minimally invasive cardiac surgery for children.Methods 60 pediatric patients with congenital heart diseases undergoing minimally invasive surgery were randomly divided into two groups(group A and group B,n=30).The anaesthesia was performed through single-cavity tube in the trachea.In group A,combined with lung protection that decreased lung injury,the improved breathe management by decreasing tidal volume,increasing breath rate and regulating the inspiration time and expiratory time ratio was used to exposure the operation sits,whereas the routine high frequency ventilation(HFV)was employed in group B.The effects of these two respiratory managements on the operation and prognosis were observed.Results There were no complications such as serious cardiac arrhythmia,morbidity of remains leak and pulmonary edema.Compared to group B,the blood dynamics was steady in the operation in group A,and the incidence of hypoxemia,hypercarbia,extracorporeal circulation time,assisted ventilation time,admission time in ICU and days in hospital of group A were significantly less(P<0.05).Conclusions The application of improved respiratory management in minimally invasive cardiac surgery for children in pediatric can acquire adequate surgical exposure for the operation and reduce complications of lung,decrease the assisted ventilation time and admission time post-operation.更多还原