2018 年第 5 期 第 13 卷

不同通气模式在先天性心脏病婴儿术后撤机拔管中的效果比较

Effects of different ventilatory modes on weaning from mechanical ventilation after congenital heart disease surgery in infants

作者：魏丹罗毅任晓旭吴涛秦广宁屈昕芃王双兴杨翔马则铭张辉

英文作者：

单位：100020北京，首都儿科研究所心脏外科

英文单位：

关键词：先天性心脏病；机械通气；撤机

英文关键词：

• 摘要：

• 目的    比较同步间歇指令通气（压力调节容量控制通气）联合压力支持［SIMV(PRVC)+PS］模式与压力支持/持续气道正压通气（PS/CPAP）模式在先天性心脏病婴儿术后撤机拔管中的效果。方法    选取2016年9月至2017年5月首都儿科研究所收治的1～6月龄左向右分流型先天性心脏病行双心室根治术患儿58例。所有患儿返回监护室后均给予SIMV(PRVC)+PS模式呼吸支持。待血流动力学平稳，患儿清醒自主呼吸恢复后完全随机分为SIMV(PRVC)+PS组（A组，29例）及PS/CPAP组（B组，29例）进行撤机拔管。比较2组试停时间、血流动力学指标、自主呼吸指标、动脉血氧分压和动脉血二氧化碳分压及撤机成功率的差异。结果    B组试停时间短于A组［（71±55）min比（112±59）min］，差异有统计学意义（P＜0.05）。2组患儿试停前、试停中、试停后心率、收缩压、呼吸频率、动脉血氧分压、动脉血二氧化碳分压比较，差异均无统计学意义（均P＞0.05）。2组患儿的撤机成功率均为100%。结论    PS/CPAP模式较SIMV(PRVC)+PS模式试停时间更短，试停过程中呼吸及血流动力学稳定，患儿能很好的耐受。

• 【Abstract】Objective    To analyze the effects of synchronized intermittent mandatory ventilation（pressure-regulated volume-controlled ventilation） combined with pressure support［SIMV(PRVC)+PS］ and pressure support/continuous positive airway pressure ventilation（PS/CPAP） on weaning from mechanical ventilation after congenital heart disease surgery in infants. Methods    Fifty-eight children（1-6 months old） with left-to-right shunt congenital heart disease undergoing biventricular repair from September 2016 to May 2017 in Capital Institute of Pediatrics were enrolled. All children had SIMV(PRVC)+PS after surgery. With stable hemodynamics and spontaneous respiration, the children were randomly allocated to have SIMV(PRVC)+PS(group A, n=29) PS/CPAP(group B, n=29) weaning from respiratory support. Weaning time, hemodynamic indicators, spontaneous respiratory indicators, arterial partial pressure of oxygen（PaO2）, arterial partial pressure of carbon dioxide（PaCO2） and the success rate of weaning were analyzed. Results    Weaning time in group B was significantly shorter than that in group A［(71±55)min vs (112±59)min］(P＜0.05). There were no significant differences of heart rate, systolic blood pressure, respiratory rate, PaO2 and PaCO2 between groups(P＞0.05). The success rate of weaning was 100% in both groups. Conclusion    PS/CPAP is better than SIMV(PRVC)+PS with a shorter weaning time and stable respiratory and hemodynamic status during weaning period in infants with congenital heart disease surgery.

  【Key words】Congenital heart disease；Mechanical ventilation；Weaning

  【Fund program】Capital Institute of Pediatrics Incubation Program（PY-2017-02）