董向阳 李文静 翟波

[摘要] 目的 探讨综合治疗方案对小儿心脏病术后急性呼吸窘迫综合征（ARDS）的效果。 方法 选择2007年1月～2014年12月行先天性心脏病手术后发生ARDS的患儿110例，按照不同的治疗方法分为观察组和对照组。对照组给予传统药物联合通气的治疗方案。观察组在对照组治疗基础上加入呼吸道管理，镇静、镇痛以及营养支持治疗的综合治疗方案。对比两组的治疗效果。 结果 观察组的有效率为91.5%，高于对照组的78.4%，差异有统计学意义（P<0.05）。观察组存活患儿出院时的免疫指标（总蛋白、淋巴细胞数、CD3、CD4）高于对照组（P<0.05）。 结论 综合疗法治疗小儿心脏病术后ARDS，可明显提高治疗效果。

[关键词] 急性呼吸窘迫综合征；通气治疗；营养支持；补液治疗

[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0056-03

Effect of comprehensive therapeutic regimen on acute respiratory distress syndrome after children with heart disease surgery

DONG Xiang-yang LI Wen-jing ZHAI Bo

Department of Cardiothoracic Surgery，Zhengzhou Children′s Hospital，Zhengzhou 450000，China

[Abstract] Objective To explore the effect of comprehensive therapeutic regimen on acute respiratory distress syndrome （ARDS） after children with heart disease surgery. Methods From January 2007 to December 2014，110 pediatric patients with ARDS after congenital heart disease surgery were selected. According to different therapeutic method，they were divided into observation group and control group.In control group，conventional drug combined with ventilation was provided，while in observation group，on the basis of the control group，comprehensive therapeutic regimen including respiratory tract management，sedation，analgesia and nutritional support was added.The therapeutic effect between two groups was compared. Results The effective rate in observation group （91.5%） was higher than that of control group （78.4%），and there was a statistical difference （P<0.05）.In observation group，immune indicators （total protein，lymphocyte count，CD3 and CD4） in these survival infants discharged from hospital was higher than that of control group respectively （P<0.05）. Conclusion In the treatment of ARDS after pediatric heart disease surgery，comprehensive therapeutic regimen can significantly improve the therapeutic effect.

[Key words] Acute respiratory distress syndrome；Ventilation therapy；Nutritional support；Fluid replacement therapy

急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是心脏病术后常见的并发症，具有起病急、进展快的特点，对患者生命安全造成严重威胁[1]，特别是小儿心脏病术后ARDS患者，若未能及时抢救，容易导致呼吸心脏骤停，病死率较高[2]，因此，研究小儿自身的发病特点和病理、生理特点，给予及时、正确的治疗具有重要意义。传统药物联合通气治疗的方法需要长时间借助呼吸机通气，并发症多，疗效和依从性较差[3]。随着医学诊疗水平的不断发展，针对ARDS的治疗临床上采用在传统治疗方案基础上加强补液、营养支持以及变换体位的综合治疗方案，取得了满意的效果。

1 资料与方法

1.1 一般资料

选择我院2011年1月～2014年12月行先天性心脏病手术后发生ARDS的患儿59例，男40例，女19例，年龄1～5岁，平均（2.5±0.8）岁；体重11～22 kg，平均（12.5±1.2）kg；发病时间在术后12～78 h，平均（46±5）h；拔除气管插管前发病51例，拔除气管插管后发病8例。所有患儿均表现出不同程度的烦躁、呼吸困难并伴血痰。……