外源性表面活性物質對體外循環術后急性肺損傷嬰兒脫機及呼吸力學的影響_《中國呼吸與危重監護雜志》

作者：

 崔勤 , 趙榮 , 鄭霄 , 朱海龍 , 鄭奇軍 , 張勝利

第四軍醫大學西京醫院心血管外科中心（陜西西安 710033）;

關鍵詞：

外源性肺表面活性物質嬰幼兒呼吸力學體外循環手術撤機困難

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目的探討外源性肺表面活性物質（PS）對體外循環術后急性肺損傷（ALI）嬰幼兒患者脫機及呼吸力學影響。方法體外循環術后患嬰12例術后出現ALI和脫機困難，給予肺保護性通氣策略及PS進行治療，觀察血氣、呼吸力學變化及脫機情況。結果氣管內給藥后嬰幼兒患者自主呼吸平穩，自主呼吸頻率明顯降低，自主呼吸潮氣量明顯增加，三凹征消失，胸骨凹陷減輕，PaCO2明顯降低，氣道峰壓（PIP）由（36.18±10.25）cm H2O下降到（25.11±5.14）cm H2O，肺靜態順應性（Cstat）由治療前的（1.49±0.65）mL·cm H2O-1·kg-1上升到治療后6 h的（1.95±0.50）mL·cm H2O-1·kg-1；氣道阻力（Raw）由治療前的（128.17±26.34）cm H2O·L-1·s-1下降到（78.56±18.22）cm H2O·L-1·s-1。12例嬰幼兒患者用藥后均撤機成功。結論肺保護性通氣策略聯合應用PS可明顯改善心臟病嬰幼兒患者術后呼吸力學指標，提高肺肺動態順應性、降低氣道阻力，減少患嬰呼吸功耗，使呼吸機撤離容易。

引用本文： 崔勤,趙榮,鄭霄,朱海龍,鄭奇軍,張勝利. 外源性表面活性物質對體外循環術后急性肺損傷嬰兒脫機及呼吸力學的影響. 中國呼吸與危重監護雜志, 2008, 08(2): 124-127. doi: 復制

1.	Lutz CJ,Picone A,Gatto LA,et al.Exogenous surfactant and positive end-expiratory p ressure in the treatment of endotoxin-induced lung injury.Crit CareMed,1998,26:1379-1389.
2.	Fraisse A,Paut O,Viard L,et al.Recent developments in the treatment of pediatric acute respiratory distress syndrome.Arch Pediatr,1998,5:1107-1121.
3.	Lachmann B.Open up the lung and keep the lung open.Intensive Care Med,1992;18:319-321.
4.	汪曾煒,劉維永,張寶仁,主編.手術學全集·心血管外科卷.北京:人民軍醫出版社,1996,156-158.
5.	Haslam PL,Baker CS,Hughes DA,et al.Pulmonary surfactant composition early in development of acute lung injury after cardiopulmonary bypass: prophylactic use of surfactant therapy.Int J Exp Pathol.1997,78:277-289.
6.	Griese M,Wilnhammer C,Jansen S,et al.Cardiopulmonary bypass reduces pulmonary surfactant activity in infants.J Thorac Cardiovasc Surg,1999,118:237-244.
7.	Paul DA,Greenspan JS, Davis DA,et al. The role of cardiopulmonary bypass and surfactant in pulmonary decompensation after surgery for congenital heart disease.J Thorac Cardiovasc Surg,1999,117:1025-1026.
8.	Chai PJ,Williamson JA,Lodge AJ,et al.Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass.Ann Thorac Surg,1999,67:731-735.
9.	Millar KJ,Dargaville PA,South M,et al.Pulmonary surfactant and cardiopulmonary bypass in infants.J Thorac Cardiovasc Surg,2000,119:192-193.
10.	Veldhuizen RA,Ito Y,Marcou J,et al.Effects of lung injury on pulmonary surfactant aggregate conversion in vivo and in vitro.Am J Physiol,1997,272:L872-L878.
11.	Asimakopoulos G,Smith PL,Ratnatunga CP,,et al.Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass.Ann Thorac Surg,1999,68:1107-1115.
12.	McGowan FX Jr,Ikegami M,del Nido PJ,et al.Cardiopulmonary bypass significantly reduces surfactant activity in children.J Thorac Cardiovasc Surg,1993,106:968-977.
13.	Raymondos K,Leuwer M,Haslam PL,et al.Compositional,structural,and functional alteration pulmonary surfactantin surgical patients after the early onset of systemic inflammatory response syndrome or sepsis.Crit Care Med,1999,27:12-13.

1. Lutz CJ,Picone A,Gatto LA,et al.Exogenous surfactant and positive end-expiratory p ressure in the treatment of endotoxin-induced lung injury.Crit CareMed,1998,26:1379-1389.
2. Fraisse A,Paut O,Viard L,et al.Recent developments in the treatment of pediatric acute respiratory distress syndrome.Arch Pediatr,1998,5:1107-1121.
3. Lachmann B.Open up the lung and keep the lung open.Intensive Care Med,1992;18:319-321.
4. 汪曾煒,劉維永,張寶仁,主編.手術學全集·心血管外科卷.北京:人民軍醫出版社,1996,156-158.
5. Haslam PL,Baker CS,Hughes DA,et al.Pulmonary surfactant composition early in development of acute lung injury after cardiopulmonary bypass: prophylactic use of surfactant therapy.Int J Exp Pathol.1997,78:277-289.
6. Griese M,Wilnhammer C,Jansen S,et al.Cardiopulmonary bypass reduces pulmonary surfactant activity in infants.J Thorac Cardiovasc Surg,1999,118:237-244.
7. Paul DA,Greenspan JS, Davis DA,et al. The role of cardiopulmonary bypass and surfactant in pulmonary decompensation after surgery for congenital heart disease.J Thorac Cardiovasc Surg,1999,117:1025-1026.
8. Chai PJ,Williamson JA,Lodge AJ,et al.Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass.Ann Thorac Surg,1999,67:731-735.
9. Millar KJ,Dargaville PA,South M,et al.Pulmonary surfactant and cardiopulmonary bypass in infants.J Thorac Cardiovasc Surg,2000,119:192-193.
10. Veldhuizen RA,Ito Y,Marcou J,et al.Effects of lung injury on pulmonary surfactant aggregate conversion in vivo and in vitro.Am J Physiol,1997,272:L872-L878.
11. Asimakopoulos G,Smith PL,Ratnatunga CP,,et al.Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass.Ann Thorac Surg,1999,68:1107-1115.
12. McGowan FX Jr,Ikegami M,del Nido PJ,et al.Cardiopulmonary bypass significantly reduces surfactant activity in children.J Thorac Cardiovasc Surg,1993,106:968-977.
13. Raymondos K,Leuwer M,Haslam PL,et al.Compositional,structural,and functional alteration pulmonary surfactantin surgical patients after the early onset of systemic inflammatory response syndrome or sepsis.Crit Care Med,1999,27:12-13.

《中國呼吸與危重監護雜志》

外源性表面活性物質對體外循環術后急性肺損傷嬰兒脫機及呼吸力學的影響

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《中國呼吸與危重監護雜志》

外源性表面活性物質對體外循環術后急性肺損傷嬰兒脫機及呼吸力學的影響

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