目的 探討≤10 kg體重嬰幼兒心臟直視術后呼吸機使用時間的相關因素。 方法 從2005年3月－2011年6月，選擇納入接受心臟直視手術的體重≤10 kg的先天性心臟病嬰幼兒，分析各項圍術期指標與術后呼吸機使用時間的關系，討論該類嬰幼兒術后呼吸機使用時間決策。 結果 共納入體重≤10 kg的嬰幼兒42例，呼吸機使用時間（42.74 ± 52.55） h，中位數20.88 h;發現術后2 h入量（mL/kg），術后4、8、16 h總入量（mL/kg）與術后呼吸機使用時間相關（P＜0.05），術后呼吸機使用時間與患兒ICU入住時間約成線性相關（P＜0.05）。 結論 影響低體重嬰幼兒心臟直視術后呼吸機使用時間是術后液體管理，實施“限制性液體管理”治療策略可能會促進患兒的術后快速康復。術后液體管理如何具體影響患兒呼吸機使用時間，影響患兒的預后，尚需進一步研究。Objective To evaluate the factors related to the postoperative mechanical ventilation (MV) duration in low-weight infants weighing less than 10 kg having undergone open cardiac surgery. Methods From March 2005 to June 2011, infants less than 10 kg undergoing congenital cardiac surgery were included in this research. We analyzed the relationship between various peri-operative indexes and the duration of MV, and discussed the decision for ventilation time for these infant patients. Results A total of 42 infants were included in our study. The ventilation time was (42.74 ±52.55) hours with a median of 20.88 hours. The postoperative second-hour fluid intake and the total intake of fluid at hour 4, 8, and 16 were related to the duration of mechanical ventilation (P＜0.05). And the ventilation time had a linear relationship with the ICU-stay time (P＜0.05). Conclusions The postoperative fluid management is associated with the duration of mechanical ventilation for low-weight infants having undergone open cardiac surgery. “Fluid controlling management” may facilitate quick recovery of the infant patients. However, as for how the fluid should be managed, how the fluid management influences ventilation time and the prognosis, more research is needed.
【摘要】 目的 總結先天性心臟病術后無創通氣的監護。 方法 2008年1-12月胸外ICU 36例先天性心臟病術后患兒，在使用無創通氣前后監測血壓、心率、呼吸及血氣變化。 結果 與無創通氣前相比，無創通氣后30 min、1 h、2 h的指標均恢復到滿意水平，循環穩定。 結論 通過采用無創通氣，80%的患兒避免了再次插管，縮短有創通氣時間，同時避免了相關的呼吸道并發癥，縮短了患兒住院時間，節省了醫療費用，提升了先天性心臟病患兒術后成活率。【Abstract】 Objective To summarize the nursing experience of noninvasive ventilation for infants with congenital heart disease after the surgery. Methods A total of 36 patients who underwent noninvasive ventilation from January to December 2008 were enrolled. The blood pressure, heart rate, respiration, and blood gas were recorded and analyzed before and after noninvasive ventilation. Results Compared with the results before noninvasive ventilation, all of the indexes returned to a satisfying level and the circulation kept stable 30 minutes, one hour, and two hours after noninvasive ventilation. Conclusion Noninvasive ventilation may avoid reintubation, shorten the invasive ventilatory time, decrease the respiratory complications, shorten the time of hospitalization, save the medical expenses, and promote the survival rate of infants with congenital heart disease.
