上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (6): 781-785.doi: 10.3969/j.issn.1674-8115.2021.06.013

• 论著 · 临床研究 • 上一篇    下一篇

呼气末正压对侧卧位体外循环下行先天性心脏病纠治术患儿肺不张发生率的影响

贺盼, 孙瑛(), 杨艳艳, 白洁, 郑吉建, 张马忠   

  1. 上海交通大学医学院附属上海儿童医学中心麻醉科,上海 200127
  • 出版日期:2021-06-28 发布日期:2021-06-29
  • 通讯作者: 孙瑛 E-mail:yingsun821@163.com
  • 作者简介:贺盼(1987—),女,住院医师,学士;电子信箱:hp878888 @ 163.com。

Effect of positive end-expiratory pressure on the incidence of atelectasis in children with congenital heart disease undergoing lateral thoracotomy under cardiopulmonary bypass

Pan HE, Ying SUN(), Yan-yan YANG, Jie BAI, Ji-jian ZHENG, Ma-zhong ZHANG   

  1. Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2021-06-28 Published:2021-06-29
  • Contact: Ying SUN E-mail:yingsun821@163.com

摘要:

目的·应用肺超声评估侧卧位体外循环(cardiopulmonary bypass,CPB)下行先天性心脏病纠治术患儿肺不张的发生率,探讨呼气末正压(positive end-expiratory pressure,PEEP)对此类患儿肺不张发生率的影响。方法·纳入2019年10月—2020年8月于上海交通大学医学院附属上海儿童医学中心择期侧卧位CPB下行先天性心脏病纠治术的患儿60例,采用随机数字表将患儿随机分为PEEP组(P组,n=30)和对照组(C组,n=30)。P组患儿在气管插管后即刻予5 cmH2O PEEP维持,直至手术结束。C组患儿在气管插管后即刻予5 cmH2O PEEP维持,直至手术开始。分别于机械通气后1 min(T1)、手术开始前1 min(T2)、手术后即刻(T3)共3个时间点行肺超声检查。记录2组患儿的肺超声评分,比较其肺不张的发生率。结果·2组患儿在T1、T2时肺不张的发生率均无统计学意义,在T3时P组患儿肺不张发生率较C组明显降低(P=0.000)。C组患儿在T3时的肺不张发生率较T1、T2时明显升高(均P<0.05)。结论·PEEP可显著降低侧卧位CPB下行先天性心脏病纠治术患儿肺不张的发生率。

关键词: 肺不张, 呼气末正压, 肺超声, 先天性心脏病, 侧卧位开胸手术

Abstract:

Objective·To evaluate the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) by lung ultrasound, and investigate the effect of positive end-expiratory pressure (PEEP) on the incidence of atelectasis in these children.

Methods·Sixty children undergoing selective lateral thoracotomy cardiac surgery with CPB in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from October 2019 to August 2020 were included. They were randomly divided into PEEP group (P group, n=30) and control group (C group, n=30). The P group was treated with 5 cmH2O PEEP immediately after tracheal intubation until the end of operation. The C group was treated with 5 cmH2O PEEP immediately after tracheal intubation until the beginning of operation. Lung ultrasound exam was performed three times in each patient, 1 min after starting mechanical ventilation of the lungs (T1), 1 min before the beginning of surgery (T2) and the time immediately upon completion of the surgery (T3). The lung ultrasound scores of the two groups were recorded, and the incidences of atelectasis were compared.

Results·There was no significant difference in the incidences of atelectasis at T1 and T2 between the two groups. The incidence of atelectasis in P group was significantly lower than that in the C group at T3 (P=0.000). The incidence of atelectasis in the C group at T3 was significantly lower than those at T1 and T2 (all P<0.05).

Conclusion·PEEP can significantly reduce the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with CPB.

Key words: atelectasis, positive end-expiratory pressure (PEEP), lung ultrasound, congenital heart disease, lateral thoracotomy

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