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目的改良二氧化碳(CO_2)充溢技术在小儿先天性心脏病手术中防止气体栓塞的安全性和有效性。方法以我院2014年1月~2015年6月心外科的90例先天性心脏病患儿为研究对象,并根据随机数字排列表分为3组(每组30例)。CO_210 L/min组(CO_2流量为10 L/min),CO_25 L/min组(CO_2流量为5 L/min),对照组不采用CO_2充溢法。3组均采用头低位、心脏底部按摩等机械性手法进行排气。对3组术中的排气效果、血气分析中的血CO_2分压(Pa CO_2)、手术时间、主动脉阻断时间以及体外循环时间进行比较。结果本次研究的所有患者手术均获得了成功,3组患儿的手术时间、主动脉阻断时间以及体外循环之间比较差异均无统计学意义;主动脉开放10 min时,CO_210 L/min组(16±3)个/min和CO_25 L/min组(23±4)个/min的脑膜中动脉气泡数量均少于对照组(50±7)个/min,CO_210 L/min组的气泡数目也少于CO_25 L/min组,差异具有统计学意义(均P<0.05);停止体外循环后,3组脑膜中动脉气泡的数量差异无统计学意义;主动脉开放时以及停止体外循环时,3组的Pa CO_2的差异均无统计学意义。结论改良后的CO_2充溢技术用于小儿先天性心脏病手术可明显减少气体栓子的数量,气流较大效果更好,且安全性较好。
Objective To improve the safety and efficacy of carbon dioxide (CO2) insufflation to prevent gas embolism in children with congenital heart disease. Methods Totally 90 children with congenital heart disease undergoing cardiac surgery from January 2014 to June 2015 in our hospital were divided into three groups (30 in each group) according to random number table. CO_2 flow rate was 10 L / min, CO_ 25 L / min CO_2 flow rate was 5 L / min, and CO_2 flush method was not used in the control group. 3 groups were used head low, bottom of the heart massage and other mechanical methods of exhaust. The exhaust effect of the three groups, Pa CO2, blood gas analysis, operation time, aortic cross-clamping time and cardiopulmonary bypass time were compared. Results All the patients in this study had successful operation. There was no significant difference in the operation time, aortic cross-clamping time and cardiopulmonary bypass between the three groups. When the aorta was opened for 10 min, CO 2 10 L / min The number of meningeal arterial air bubbles in group (16 ± 3) / min and CO_25 L / min (23 ± 4) / min was less than that in control group (50 ± 7) / min, and the number of air bubbles in CO_210 L / min group (P <0.05). After stopping the cardiopulmonary bypass, there was no significant difference in the numbers of bubble in the middle meningeal artery of the three groups. When the aorta was open and the cardiopulmonary bypass was stopped There was no significant difference in PaCO_2 among the three groups. Conclusion The modified CO_2-filled technique can reduce the number of gas emboli obviously in children with congenital heart disease. The airflow is better and the safety is better.