小儿心脏术后急性呼吸窘迫综合征的预防及治疗

为探讨小儿心脏术后急性呼吸窘迫综合征（ARDS）的临床发病特点及治疗对策，对23例ARDS患儿（包括早期发病8例、迟发15例）采用：①限制吸气峰压≤35cmH2O(3.43kPa)；②早期应用呼气末正压（PEEP）8-12cmH2O(0.78-1.18kPa)；③反复性侧卧体位等措施。结果23例中1例（1/23）继发感染、急性肾功能衰竭死亡；并发气胸2例（2/23）；严重肺不张3例（3/23）；痰培养阳性5例（5/23）。结果显示：对ARDS高危患儿应慎重选择早期拔管指征；对诊断明确者应用低容量限压通气配合体位变换可减少并发症、提高治愈率。

The Preventive and Treatment Strategy in Pediatric Patients with Acute Respiratory Distress Syndrome after Open Heart Surgery

To sum up the clinical course and treatment strategy of pediatricpatients with acute respiratory, distress syndrome (ARDS) after open heart surgery, we studied 23 pediatric ARDS patients including early episode in 8 cases and late episode in 15 cases. The maneuvers we performed were as follow:①Applying low peak inspiratory pressure ≤35 cm H2O; ②Using PEEP 8～12 cm H2O in the early period; ③Repeated lateral positioning.Results:1 case (1/23) died because of infection and acute renal failure, 2 cases (2/23) complicated with pneumothorax, 3 cases (3/23) with serious atelectasis and 5 cases (5/23) with positive sputum culture. Conclusion : We consider that choosing early extubation with discretion and applying low-volume pressure-limited ventilation combined with repeated lateral positioning can lower the Complications and mortality in the treatment of ARDS.