毕良学, 金丹群. 先天性心脏病心内直视手术后呼吸机及气道管理体会[J]. 蚌埠医科大学学报, 2004, 29(6): 495-497.
    引用本文: 毕良学, 金丹群. 先天性心脏病心内直视手术后呼吸机及气道管理体会[J]. 蚌埠医科大学学报, 2004, 29(6): 495-497.
    BI Liang-xue, JIN Dan-qun. Management of respirator and airway after open heart surgery for congenital heart disease[J]. Journal of Bengbu Medical University, 2004, 29(6): 495-497.
    Citation: BI Liang-xue, JIN Dan-qun. Management of respirator and airway after open heart surgery for congenital heart disease[J]. Journal of Bengbu Medical University, 2004, 29(6): 495-497.

    先天性心脏病心内直视手术后呼吸机及气道管理体会

    Management of respirator and airway after open heart surgery for congenital heart disease

    • 摘要: 目的: 总结先天性心脏病(先心病)心内直视术后呼吸机应用及气道管理的体会。方法: 术后均选用同步间歇指令通气(SIMV)+呼气末正压(PEEP)+压力支持通气(PSV)模式辅助呼吸,常规监测经皮氧饱和度、呼气末二氧化碳分压、有创动脉血压、血气等呼吸循环指标。结果: 撤机后出现明显呼吸困难17例,再插管5例,另12例改用CPAP后呼吸困难改善,避免了2次插管。本组52例行气管分泌物培养及涂片,19例阳性,其中8例培养为肺炎克雷伯杆菌,11例涂片为霉菌孢子,根据药敏结果调整抗生素后肺部感染全部控制。本组肺不张15例,气胸3例,给予加强体位引流、胸腔穿刺抽气后治愈。结论: 先心病术后呼吸机辅助通气是十分重要的,提倡循环稳定时早期撤机;对于撤机后呼吸困难者,尽早给予CPAP支持,对难以控制的肺部感染要根据气管分泌物培养及涂片结果调整抗生素。

       

      Abstract: Objective: To summarize the experience in the application of mechanical ventilation and airway management after the open heart surgery for congenital heart disease.Methods: SIMV and PEEP and PSV model was performed after the operation and SpO2,ETCO2、BP and blood gas were monitored.Results: Seventeen cases developed dyspnea after the removal of the mechanical ventilation,and 5 of them had to resume using the mechanical ventilation.And the dyspnea in the other 12 cases was relieved by continuous positive pressure ventilation(CPAP).The intratracheal secretion culture and smear test were carried out in 52 cases were.The results were positive in 19 cases,8 cases had Klebsiella pneumonia and 11 cases fungi.Fifteen cases had pulmonary atelectasis and 3 cases pneumethorax.Conclusions: The mechanical ventilation is essential for the patients with congenital heart disease after the operation,but the mechanical ventilation should be removed as early as possible.To the patients presenting dyspnea after the removal of the mechanical ventilation,CPAP should be restored immediately.Antibiotics should be applied to the patients with pneumonia according to the results of the intratracheal secretion culture and smear test.

       

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