Shekerdemian L S, Bush A, Lincoln C, Shore D F, Petros A J, Redington A N
Department of Paediatrics, Royal Brompton Hospital, London, UK.
Heart. 1997 Dec;78(6):587-93. doi: 10.1136/hrt.78.6.587.
To investigate the effects of cuirass negative pressure ventilation on the cardiac output of a group of anaesthetised children after occlusion of an asymptomatic persistent arterial duct, and a group of paediatric patients in the early postoperative period following cardiopulmonary bypass.
Prospective study.
The paediatric intensive care unit and catheter laboratory of a tertiary care centre.
16 mechanically ventilated children were studied: seven had undergone surgery for congenital heart disease, and nine cardiac catheterisation for transcatheter occlusion of an isolated asymptomatic persistent arterial duct.
Cardiac output was measured using the direct Fick method during intermittent positive pressure ventilation and again after a short period of negative pressure ventilation. In five of the postoperative patients a third measurement was made following reinstitution of positive pressure ventilation.
Negative pressure ventilation was delivered without complication, with no significant change in systemic arterial oxygen and carbon dioxide tension. The mixed venous saturation increased from 74% to 75.8% in the healthy children, and from 58.9% to 62.3% in the postoperative group. Negative pressure ventilation increased the cardiac index from 4.0 to 4.5 l/min/m2 in the healthy children, and from 2.8 to 3.5 l/min/m2 in the surgical group. The increase was significantly higher in the postoperative patients (28.1%) than the healthy children (10.8%).
While offering similar ventilatory efficiency to positive pressure ventilation, cuirass negative pressure ventilation led to a modest improvement in the cardiac output of healthy children, and to a greater increase in postoperative patients. There are important cardiopulmonary interactions in normal children and in children after cardiopulmonary bypass, and by having beneficial effects on these interactions, negative pressure ventilation has haemodynamic advantages over conventional positive pressure ventilation.
研究胸甲式负压通气对一组无症状持续性动脉导管封堵术后麻醉儿童以及一组体外循环术后早期儿科患者心输出量的影响。
前瞻性研究。
三级医疗中心的儿科重症监护病房和导管实验室。
对16例机械通气儿童进行了研究：7例接受了先天性心脏病手术，9例接受了经心导管封堵孤立无症状持续性动脉导管的检查。
在间歇正压通气期间使用直接Fick法测量心输出量，在短时间负压通气后再次测量。5例术后患者在恢复正压通气后进行了第三次测量。
负压通气实施过程中无并发症发生，体动脉血氧和二氧化碳张力无显著变化。健康儿童的混合静脉饱和度从74%升至75.8%，术后组从58.9%升至62.3%。负压通气使健康儿童的心指数从4.0升至4.5升/分钟/平方米，手术组从2.8升至3.5升/分钟/平方米。术后患者的心指数升高幅度（28.1%）显著高于健康儿童（10.8%）。
胸甲式负压通气虽然与正压通气具有相似的通气效率，但能使健康儿童的心输出量适度增加，使术后患者的心输出量增加更多。正常儿童和体外循环术后儿童存在重要的心肺相互作用，负压通气通过对这些相互作用产生有益影响，在血流动力学方面优于传统正压通气。
