2023 年第 7 期 第 18 卷

二氧化碳术野填充技术在儿童右腋下小切口体外循环手术中的排气应用效果

The effect of carbon dioxide surgical field filling technology exhaust application in children′s right subaxillary small incision cardiopulmonary bypass surgery

作者：郭张科李志敏范凡童峰郑佳李奇林李培柏松李晓峰

英文作者：Guo Zhangke Li Zhimin Fan Fan Tong Feng Zheng Jia Li Qilin Li Pei Bai Song Li Xiaofeng

单位：国家儿童医学中心首都医科大学附属北京儿童医院心脏外一科，北京100045

英文单位：The First Department of Cardiac Surgery Beijing Children′s Hospital Capital Medical University National Center for Children′s Health Beijing 100045 China

关键词：先天性心脏病；二氧化碳术野填充；右腋下小切口

英文关键词：Congenitalheartdisease;Carbondioxidesurgicalfieldfilling;Rightsubaxillarysmallincision

• 摘要：

• 目的  探讨自主研发的二氧化碳术野填充装置在儿童右腋下小切口体外循环手术中的排气应用效果。方法  选取2022年4—10月于首都医科大学附属北京儿童医院进行右腋下小切口入路体外循环手术的简单先天性心脏病患儿71例，按术中排气方法分为不应用二氧化碳术野填充装置的对照组（41例）和在外科传统手法排气基础上加用二氧化碳术野填充装置进行辅助排气的观察组（30例）。比较2组围手术期动脉血气相关指标、血生化及血常规相关指标和心脏复跳异常及干预情况。结果  对照组和观察组患儿体外循环开始后30 min的动脉血二氧化碳分压（PaCO2）［（37.4±5.4）mmHg（1 mmHg=0.133 kPa）比（42.4±5.8）mmHg］、pH值、碱剩余、血乳酸及回心脏重症监护病房后首次动脉血气测得PaCO2比较差异均有统计学意义（均P＜0.05）。术后第3天2组C反应蛋白比较差异有统计学意义（P=0.002）。2组患儿心脏复跳异常、ST段异常抬高、心律失常、复跳异常患儿进行临床干预比例比较，差异均有统计学意义（均P＜0.05）。结论  右腋下小切口入路行体外循环手术患儿在外科传统手法排气基础上加用二氧化碳术野填充技术，可减少术中异常复跳情况的发生及干预，同时可以使术中PaCO2维持于正常值范围高限，且未发生高碳酸血症，对于术后早期心肌损伤及炎症反应具有一定的改善作用。

• Objective  By using the self-developed carbon dioxide surgical field filling device, to explore the effect of its exhaust application in children′s right subaxillary small incision cardiopulmonary bypass surgery. Methods  From April to October 2022， 71 children with simple congenital heart disease who were treated in Beijing Children′s Hospital, Capital Medical University and underwent cardiopulmonary bypass surgery via right subaxillary small incision approach were selected and divided into control group (41 cases) without carbon dioxide surgical field filling device and observation group (30 cases) with carbon dioxide surgical field filling device added to traditional surgical manual exhaust. The perioperative arterial blood gas related indexes, blood biochemical and blood routine related indexes, the abnormality in cardiac rebound and intervention in the two groups were compared. Results  There were statistically significant differences between the control group and the observation group in arterial blood partial pressure of carbon dioxide ［(37.4±5.4)mmHg vs (42.4±5.8)mmHg］, pH value, alkali surplus, blood lactic acid 30 min after cardiopulmonary bypass and partial pressure of carbon dioxide measured for the first time after returning to the cardiac intensive care unit (all P＜0.05). There was a statistically significant difference in C-reactive protein between the two groups on the third day after operation (P=0.002). There were significant differences in the proportions of children in the two groups who had abnormal cardiac rebound, abnormal ST-segment elevation, arrhythmia, and clinical interventions (all P＜0.05). Conclusions    In children undergoing cardiopulmonary bypass surgery via the right subaxillary small incision approach, the use of carbon dioxide surgical field filling technology on the basis of traditional surgical manual exhaust can reduce the occurrence and intervention of abnormal rebound during the operation, and can maintain partial pressure of carbon dioxide at the high limit of the normal range during the operation without hypercapnia, which has a certain improvement effect on early postoperative myocardial injury and inflammatory response.