Han Xia, Tian Qing, Chen Feng, Wang Yang, Chen Han
Intensive Care Unit, Wuhan Asia Heart Disease Hospital, Wuhan 430022, China; Email:
Intensive Care Unit, Wuhan Asia Heart Disease Hospital, Wuhan 430022, China.
Zhonghua Yi Xue Za Zhi. 2015 Nov 3;95(41):3347-50.
To investigate the pulmonary ultrasound in children with congenital heart disease postoperative invasive ventilator time, non-invasive ventilator use the guide.
Using prospective clinical observation research methods, Randomly divide 100 cases ranged from 6 months to 3 years old in cardiopulmonary bypass after congenital heart disease surgery patients into ultrasound group and control group, 50 cases in each group. All postoperative give positive cardiac function maintenance, diuresis, etc. Ultrasound group adopted the pulmonary ultrasound in children with pulmonary interstitial pulmonary edema monitoring and guide to extubation, enable the timing of the noninvasive ventilator support; Control group based on the bedside chest X-ray lung condition. Compare two groups of children with mechanical ventilation time (including the invasive and noninvasive ventilator support), noninvasive ventilator utilization rate and its accuracy, start the noninvasive ventilator time, the incidence of ventilator associated pneumonia (VAP), secondary tracheal intubation cases and ICU stay time, etc.
The ultrasound group compared with the control group in Invasive ventilator time [(15.0 ± 11.0) vs (20.0 ± 13.5, P=0.043)], noninvasive ventilation time [(38.5 ± 11.8) vs (48.6 ± 21.9, P=0.032)], the number of cases of the use of noninvasive ventilation (10 cases vs 22 cases, P=0.041), the correct use of the number of cases (10 vs 14, P=0.034) and VAP cases (3 vs 8, P=0.044), there was statistical significance, P< 0.05. The ultrasound group of children with ICU stay time was significantly lower than the control group [(66.0 ± 38.9) vs (82.0 ± 42.4, P=0.038)]; Control group had 2 cases with secondary tracheal intubation, ultrasound group one, comparing the two groups has no statistical significance (P> 0.05).
Postoperative children with congenital heart disease using pulmonary ultrasound evaluation of pulmonary interstitial edema,guide the ventilator, it can effectively shorten (invasive and noninvasive mechanical ventilation time and ICU length of hospital stay, lung ultrasound has instant, noninvasive, No radiation, repeatable,pulmonary ultrasound will be important after cardiopulmonary bypass interstitial lung edema diagnosis, evaluation of treatment means and helps to treat critically ill children.
探讨肺部超声在先天性心脏病患儿术后有创通气时间、无创通气使用方面的指导作用。
采用前瞻性临床观察研究方法,将100例年龄6个月至3岁的先天性心脏病手术后体外循环患者随机分为超声组和对照组,每组50例。术后均给予积极的心功能维护、利尿等处理。超声组采用肺部超声对患儿肺间质肺水肿进行监测并指导拔管时机,确定无创通气支持时机;对照组依据床边胸部X线判断肺部情况。比较两组患儿机械通气时间(包括有创和无创通气支持时间)、无创通气使用率及其准确性、开始无创通气时间、呼吸机相关性肺炎(VAP)发生率、二次气管插管例数及ICU住院时间等。
超声组与对照组相比,有创通气时间[(15.0±11.0)对(20.0±13.5),P = 0.043]、无创通气时间[(38.5±11.8)对(48.6±21.9),P = 0.032]、无创通气使用例数(10例对22例,P = 0.041)、正确使用例数(10对14,P = 0.034)及VAP例数(3对8,P = 0.044),差异均有统计学意义,P < 0.05。超声组患儿ICU住院时间明显低于对照组[(66.0±38.9)对(82.0±42.4),P = 0.038];对照组有2例二次气管插管,超声组1例,两组比较无统计学意义(P > 0.05)。
先天性心脏病术后患儿应用肺部超声评估肺间质水肿,指导通气,可有效缩短(有创和无创)机械通气时间及ICU住院时间,肺部超声具有即时、无创、无辐射、可重复等优点,肺部超声将成为体外循环术后肺间质水肿诊断、评估及治疗的重要手段,有助于危重症患儿救治。