呼气末正压对小儿心脏手术后肺通气的影响：一项基于CT的研究。

Effect of PEEP on lung aeration in pediatric patients after cardiac surgery: a CT-Based study.

作者信息

Gimenez Solange C, Carrilho Milene C, Malbouisson Isabela M, de Abreu Marcelo Gama, Rouby Jean-Jacques, Malbouisson Luiz Marcelo Sá

机构信息

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Anestesia, São Paulo, SP, Brazil.

University Paris-Sorbonne (UPMC Paris 06), Hôpital de la Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Multidisciplinary Intensive Care Unit, Department of Anesthesiology, Paris, France.

出版信息

Braz J Anesthesiol. 2025 Apr 22;75(4):844623. doi: 10.1016/j.bjane.2025.844623.

DOI:10.1016/j.bjane.2025.844623

PMID:40274098

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12143648/

Abstract

BACKGROUND

Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.

METHODS

Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm HO. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.

RESULTS

Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 ± 2.3 kg. Cardiopulmonary bypass duration was 77 ± 26 minutes. Preoperatively, pulmonary volume was 545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.

CONCLUSION

Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm HO restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.

摘要

背景

在接受体外循环心脏手术的成年患者中，经常观察到肺通气丧失。然而，在儿童中，先天性心脏缺陷手术修复后肺通气的变化以及呼气末正压（PEEP）的影响仍不确定。

方法

对12例患有先天性非紫绀型心脏病且肺血流量增加的儿童进行了研究，这些儿童在体外循环下接受了完全手术修复。在术前自主呼吸期间以及术后机械通气时，呼气末正压分别为0、5和10 cmH₂O时进行肺部计算机断层扫描。测量气体和组织肺体积及质量，以及未通气、通气不良和通气正常的肺区。

结果

患者的中位年龄为18.3个月（4至24个月），体重为9.3±2.3 kg。体外循环持续时间为77±26分钟。术前，肺体积为545 mL（237 - 753 mL），其中组织和气体体积分别为48.4%（41.7% - 59.6%）和51.6%（40.4% - 58.3%）。未通气和通气正常的肺区分别占肺组织的15%和47.9%。术后，在零PEEP时，未通气肺区增加到27%，而通气正常的肺区则降至38.5%。逐步应用PEEP可使通气正常的肺体积恢复到术前水平，但未显著减少未通气实质。