论文部分内容阅读
目的分析法洛四联症(TOF)根治术后急性肺损伤(ALI)的原因,总结治疗体会。方法2003年7月至2004年6月,上海第二医科大学附属新华医院上海儿童医学中心心胸外科共行TOF根治术161例,发生ALI5例。记录5例ALI患儿术前经皮氧饱和度(SpO2)、红细胞压积比(HCT)、McGoon比值、肺动脉指数(PAI)和手术、体外循环(CPB)资料,以及ALI发生时间、ALI发生后各项治疗措施、各治疗阶段肺功能指标、计算其肺损伤分数。结果5例ALI患儿,年龄7～24(13.8±3.1)个月,体重7.0～9.5(8.2±0.5)kg,均在静吸复合麻醉CPB下进行,术毕给予改良超滤,平均CPB时间(67.2±5.9)min,主动脉阻断时间(43.6±2.4)min,ALI发生率为3.1%,发生时间为术后8～60h,死亡2例。5例均施行腹膜透析术(PD),2例给予一氧化氮吸入,1例给予肺表面活性物质替代治疗。各治疗阶段肺功能指标逐步改善,至治疗后期,肺功能指标在统计学上有显著性差异(P<0.05)。结论TOF术后ALI治疗困难,合理机械通气、尽早维持体液平衡、改善肺通气和氧合功能有利于及时阻断低氧酸中毒导致的恶性循环。
Objective To analyze the causes of acute lung injury (ALI) after radical surgery in patients with tetralogy of Fallot (TOF) and to summarize the experience of treatment. Methods From July 2003 to June 2004, 161 patients underwent TOF radical mastectomy in Shanghai Children’s Medical Center, Xinhua Hospital, Shanghai Second Medical University from July 2003 to June 2004, and ALI occurred in 5 cases. Perioperative oxygen saturation (SpO2), hematocrit (HCT), McGoon ratio, pulmonary artery index (PAI) and surgery, cardiopulmonary bypass (CPB) data were recorded in 5 children with ALI. ALI occurred After the various treatment measures, lung function indicators of each treatment stage, calculate the score of lung injury. Results Five children with ALI, aged 7-24 months (13.8 ± 3.1) months and body weight 7.0-9.5 (8.2 ± 0.5) kg, were treated with inhalation anesthesia and CPB respectively. Modified ultrafiltration and mean CPB time (67.2 ± 5.9) min, aortic block time (43.6 ± 2.4) min, and ALI incidence rate was 3.1%. Occurrence time was 8 ~ 60h after operation and 2 died. Peritoneal dialysis (PD) was performed in 5 cases, nitric oxide inhalation in 2 cases, and replacement therapy with pulmonary surfactant in 1 case. The indexes of pulmonary function gradually improved in all treatment stages. There was a statistically significant difference (P <0.05) in the indexes of pulmonary function between the treatment stage and the end of treatment. Conclusions The treatment of ALI after TOF is difficult, reasonable mechanical ventilation, maintaining body fluid balance as early as possible, and improving pulmonary ventilation and oxygenation are beneficial to timely blocking the vicious cycle caused by hypoxia.