Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
目的探讨妊娠期体外循环手术的围术期处理方法及母婴安全性。 方法回顾性分析2006年1月至2014年3月福建省立医院心外科21例妊娠期行体外循环手术患者的临床资料，年龄（26.2±3.4）岁。 结果母亲19例生存，2例死于多器官功能衰竭。婴儿6例引产，2例死亡，生存13例。随访13例存活新生儿8个月至8年，并对4例年龄大于6岁的儿童进行韦氏儿童智力量表第4版（WISC-IV）测试，得分分别为92分、104分、106分、90分，平均98分，与正常儿童无明显差异[（100±15）分]。 结论体外循环下心脏手术对于妊娠期合并严重心脏病患者是可行的，手术的危险性主要取决于手术方式、手术时间、孕周、体外转流时间、是否深低温等，应采取多学科合作，根据患者具体情况制定个体化方案。