Prakanrattana U, Valairucha S, Sriyoschati S, Pornvilawan S, Phanchaipetch T
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1997 Feb;80(2):87-95.
The study of tracheal extubation time in pediatric patients who underwent open heart surgery was performed in the period of 1990-1991 (group 1) and 1992-May 1994 (group 2), composed of 174 and 208 cases in group 1 and group 2 respectively. The criteria for extubation in these patients are convention regimens with considered subsequent standard of CPB, such as fully rewarmed, hemodynamic stable with adequate cardiac output with low-dose or no inotropes/ vasodilator, without significant dysrhythmias and no significant mediastinal bleeding. The difference of postoperative fluid management between the two groups include the regimens of total fluid intake of two-thirds of daily maintenance fluid in group 1, whereas, the total fluid therapy of group 2 depended on the patients' age and body weight. The results show that, early extubation within 8 hours of ICU arrival were 20.5 per cent and 61.7 per cent in group 1 and group 2 respectively. All of the patients in group 2, after extubation, were discharged to the ward on the first postoperative day. The overnight ventilation was about 74.1 per cent and 30.6 per cent in the first and second groups respectively. The prolonged intubation (more than 24 hours) was almost the same in two groups. There was no significant complication of early extubation with the limitation of daily total fluid intake. The causes of tracheal reintubation in both groups were fluid overload and residual cardiac lesions. The prior etiology occurred in group 1 more than group 2. It was concluded that, after the change in postoperative fluid therapy regimens, early extubation following open-heart pediatric surgery is highly successful with no significant complication. The benefits of early extubation include cost savings, patient comfort, early patient mobilization, improved cardiac function, reduced respiratory complications and reduction of case cancellation due to early ICU discharge.
对1990 - 1991年（第1组）和1992年至1994年5月（第2组）接受心脏直视手术的儿科患者的气管拔管时间进行了研究，第1组和第2组分别有174例和208例。这些患者的拔管标准是符合常规方案并考虑后续的体外循环标准，如完全复温、血流动力学稳定、心输出量充足、使用低剂量或不使用血管活性药物/血管扩张剂、无明显心律失常且无明显纵隔出血。两组术后液体管理的差异包括，第1组每日总液体摄入量为每日维持液量的三分之二，而第2组的总液体治疗则取决于患者的年龄和体重。结果显示，到达重症监护病房（ICU）后8小时内早期拔管的比例在第1组和第2组分别为20.5%和61.7%。第2组所有患者拔管后均在术后第一天返回病房。第1组和第2组过夜通气的比例分别约为74.1%和30.6%。两组中长时间插管（超过24小时）的情况几乎相同。在限制每日总液体摄入量的情况下，早期拔管没有明显并发症。两组气管再次插管的原因都是液体超负荷和残留心脏病变。第1组中先前病因的发生率高于第2组。得出的结论是，在术后液体治疗方案改变后，小儿心脏直视手术后早期拔管非常成功，且无明显并发症。早期拔管的益处包括节省成本、患者舒适、患者早期活动、改善心脏功能、减少呼吸并发症以及减少因早期转出ICU而导致的手术取消。
