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目的 探讨先天性心脏病室间隔缺损（ Ｖ Ｓ Ｄ）患儿能够耐受的无通气安全时限。 方法 根据 Ｖ Ｓ Ｄ大小和术中是否补片修补将２０ 例 Ｖ Ｓ Ｄ患儿分为两组。Ⅰ组：１０ 例， Ｖ Ｓ Ｄ小于１ｃｍ ，术中直接缝合修补；Ⅱ组：１０ 例， Ｖ Ｓ Ｄ大于１ｃｍ ，术中需补片修补；对照组：８ 例，选择无心、肺疾病的手术患儿作为对照。麻醉诱导后，患儿先预吸氧３ 分钟，然后开始无通气期２ 分钟，观察无通气期血气、心率、动脉血压的变化。 结果 在无通气期，３ 组患儿的动脉血氧分压均进行性降低，到无通气２ 分钟时，Ⅱ组患儿的动脉血氧分压明显低于其它两组。动脉血二氧化碳分压随无通气时间延长逐渐升高，到无通气１ 分钟时，３ 组患儿的动脉血二氧化碳分压均高于正常值的高限，组间比较无差异。在无通气期，３ 组患儿的心率、血压无明显变化，也未观察到心律失常的发生。 结论 Ｖ Ｓ Ｄ患儿心肺功能受损程度直接同 Ｖ Ｓ Ｄ大小有关，在麻醉诱导时，应将无通气时间控制在１ 分钟之内。
Objective To investigate the tolerable time limit of ventilatory safety in children with congenital heart disease and ventricular septal defect (V S D). Methods Twenty patients with V S D were divided into two groups according to the size of V S D and patch repair. In group Ⅰ, 10 cases had VSD less than 1 cm, which was directly sutured and repaired intraoperatively. In group Ⅱ, 10 patients had V S D greater than 1 cm and had patch surgery during operation. In control group, 8 patients underwent operation without heart and lung disease Children as a control. After induction of anesthesia, children pre-oxygen for 3 minutes, then began without ventilation for 2 minutes to observe the change of blood gas, heart rate, arterial blood pressure during non-ventilated period. Results During the period of no ventilation, the arterial partial pressure of oxygen in all three groups decreased progressively. When the patients were not ventilated for 2 minutes, the partial pressure of arterial oxygen in group Ⅱ was significantly lower than that in the other two groups. The partial pressure of arterial carbon dioxide increased with the prolongation of non-ventilatory time. When there was no ventilation for 1 minute, the partial pressure of arterial carbon dioxide in all three groups was higher than the upper limit of normal, there was no difference between the two groups. In the period of no ventilation, the heart rate and blood pressure of the three groups had no obvious changes, and no arrhythmia was observed. Conclusions The severity of cardiopulmonary dysfunction in children with V S D is directly related to the size of V S D. During the induction of anesthesia, the duration of apnea should be controlled within 1 minute.