中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

不同月龄先天性心脏病婴儿术后急性呼吸窘迫综合征应用肺表面活性物质治疗的临床研究

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目的 评价肺表面活性物质(pulmonary surfactant,PS)对不同月龄先天性心脏病(先心病)婴儿术后呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)治疗效果。 方法 采用 PS 治疗先心病患儿术后 ARDS,其中2012 年 1 月至 2017年 6 月符合入选标准的患者共 43 例。分为小婴儿组(< 3 个月,12 例)、婴儿组(3 个月至 1 岁,31 例),比较两组患儿用药前后氧合和换气指标的变化情况。 结果 小婴儿组体重更低,两组患儿体外循环时间、主动脉阻断时间、机械通气时间、住 ICU 时间差异无统计学意义,两组患儿在用药前动脉血氧分压(PaO2)、氧吸入浓度(FiO2)、氧合指数(PaO2/FiO2,P/F) 及肺泡动脉氧压比( a/A )差异无统计学意义(P>0.05)。 用药治疗 24 h 后,两组患儿与用药前比较,PaO2、P/F 及 a/A 均显著升高;FiO2 明显降低,差异有统计学意义(P<0.05),用药 24 h 后,小婴儿组 PaO2、P/F 及 a/A 显著高于婴儿组,小婴儿组 FiO2 显著低于对照组。 结论 PS治疗对小月龄先心病患儿术后 ARDS 者有更好的氧合通气改善作用。

Objective To evaluate the efficacy of pulmonary surfactant (PS) on severe acute respiratory distress syndrome (ARDS) in different age baby with congenital heart disease. Methods We divided 43 baby patients into two separate groups including a little baby group (12 patients with age less than 3 months) and an infants group (31 patients with age of 3 months to one year). Both groups of patients were treated with intratracheal PS at the same time. The clinical data were collected and analyzed. Results The little baby group had lower body weight. There was no statistical difference in the cardiopulmonary bypass (CPB) time, operation blocking time, mechanical ventilation time, ICU stay time between the two groups (P>0.05). Before treatment, arterial partial presurre of oxygen (PaO2), fractional oxygen concentration in inspire gas (FiO2), the ratio of arterial PO2 to the inspired oxygen fraction (P/F) and arterial-alveolar N2 difference or gradient (a/A) had no difference between the two groups (P>0.05). After treatment, PaO2 and P/F of both groups were significantly lower than before (P<0.05), and FiO2 and P/F were significantly higher than before (P<0.05). After 24 h of treatment, PaO2 and P/F of the little baby group was significantly higher than that of the infants group (P<0.05), and FiO2 and P/F were significantly lower than those of the infants group (P<0.05). Conclusion PS treating severe ARDS in little baby with congenital heart disease has better effect than infants.

关键词: 肺表面活性物质; 先天性心脏病; 急性呼吸窘迫合征; 年龄

Key words: Pulmonary surfactant; congenital heart disease; acute respiratory distress syndrome; age

引用本文: 张荣媛, 王旭, 李守军, 闫军, 杨菊先. 不同月龄先天性心脏病婴儿术后急性呼吸窘迫综合征应用肺表面活性物质治疗的临床研究. 中国胸心血管外科临床杂志, 2018, 25(11): 977-980. doi: 10.7507/1007-4848.201801050 复制

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