麻醉安全与质控2025，Vol.7Issue(5)：376-383,8.DOI:10.3969/j.issn.2096-2681.2025.05.003
两种肺复张方法对先心病患儿体外循环手术的肺保护作用
The lung protective effects of two lung recruitment methods on children with congenital heart disease undergoing extracorporeal bypass surgery
摘要
Abstract
Objective To compare the lung protective effects of lung recruitment maneuver(RM)using the positive end-expiratory pressure(PEEP)increment method guided by lung ultrasound score(LUS)and the controlled inflation(SI)method in children with congenital heart disease(CHD)undergoing cardiopulmonary bypass(CPB)surgery.Methods A total of 84 children,aged 5 to 63 months,of American Society of Anesthesiologists(ASA)physical status Ⅰ or Ⅱ,scheduled for CPB-assisted CHD correction surgery at Henan Children's Hospital from December 2023 to February 2025 were randomly divided into the controlled inflation RM group(control group,n=42)and the PEEP increment RM group(experimental group,n=42).LUS,hemodynamic parameters,blood gas indicators,dynamic lung compliance,serum inflammatory factors[IL-6,TNF-α,procalcitonin(PCT)],postoperative pulmonary complications,extubation time,and hospital stay were compared before anesthesia induction(T0),before RM after tracheal intubation(T1),after RM after tracheal intubation(T2),before RM at the end of surgery(T3),after RM at the end of surgery(T4),at 24 h after surgery(T5),and 48 h after surgery(T6).And for each indicator at the T5 time point,stratified comparisons were conducted based on age(＜1-year-old infants and≥1-year-old toddlers).Results Compared with the control group,the experimental group had lower LUS scores and heart rate(HR)and higher mean arterial pressure(MAP)at T2,T4,T5,and T6(P＜0.05);significantly higher dynamic lung compliance at T2 and T4(P＜0.01);lower IL-6,TNF-α,and PCT levels at T3,T5,and T6(P＜0.05);higher arterial partial pressure of oxygen(PaO2)and oxygenation index(OI)at T2,T4,T5,and T6(P＜0.05 or P＜0.01);lower PPC incidence(P＜0.05);shorter extubation time(P＜0.05);and significantly shorter hospital stay(P＜0.01).Subgroup analysis showed that at T5,LUS,IL-6,PCT,and extubation time in the infant subgroup of the experimental group were lower than those in the child subgroup,while dynamic lung compliance was higher and OI was lower(P＜0.05).Conclusion LUS-guided PEEP increment RM has a significant lung protective effect in children with CHD undergoing CPB surgery,improving oxygenation,stabilizing hemodynamics,reducing inflammatory response,lowering postoperative pulmonary complications,and promoting postoperative recovery,with better effects in infants＜1 year old.关键词
先天性心脏病/肺超声评分/呼气末正压递增法肺复张/控制性肺膨胀法肺复张/体外循环/肺保护Key words
congenital heart disease/lung ultrasound score/positive end-expiratory pressure increment method lung recruitment maneuver/controlled inflation method lung recruitment maneuver/cardiopulmonary bypass/lung protection引用本文复制引用
王媛,侯玉玮,徐磊,梁娜,王玥,贾英萍,张加强..两种肺复张方法对先心病患儿体外循环手术的肺保护作用[J].麻醉安全与质控,2025,7(5):376-383,8.基金项目
河南省医学科技攻关省部共建重点项目(SBGJ202102210) （SBGJ202102210）
河南省医学科技攻关计划联合共建项目(2018020653) （2018020653）
