小児先天性心疾患手術に伴う肺コンプライアンスの変動に関する調査

Changes in Respiratory Compliance Among Infants Undergoing Surgical Repair of Congenital Heart Disease

Kitagawa Makiko

Izumi Hiromichi

Toyota Yukari

麻酔と蘇生

Ansesthesia and Resuscitation

３歳未満の心室中隔欠損症（VSD）根治術３７例を対象に術中動肺コンプライアンス（Cdyn）の変動に関する後向き観察研究を行った。測定ポイントは手術開始時（Cdyn１），人工心肺（CPB）開始前（Cdyn２），CPB離脱直後（Cdyn３），胸骨閉鎖前（Cdyn４），胸骨閉鎖後（Cdyn５）とし，統計処理は危険率５％とした。その結果，Cdyn５はCdyn１よりも有意に高かった。Cdyn２～４に有意な変動を認め，Cdyn２，３，４の順に上昇していた。関連因子（月齢，性別，体重，染色体異常の有無，肺体血流比（Qp/Qs），肺体血圧比（Pp/Ps），平均肺動脈圧（mPAP），CPB時間，大動脈遮断時間，CPB中水分バランス）毎に症例を２群に分けてDCdyn（＝ Cdyn５－ Cdyn１）を比較したところ，Qp/Qs，mPAPが高い群は低い群に比べDCdynが有意に低かった。DCdynと関連因子の重回帰分析ではmPAPがDCdynに影響する有意な因子であった。VSD根治術によりCdynは有意な改善を認め，開胸中は経時的に上昇した。また，Qp/Qs，mPAPが高い症例はCdyn改善の度合いが低くなる可能性が示唆された。

We conducted a retrospective observational study to evaluate the changes in intraoperative dynamic respiratory compliance (Cdyn) in 37 infants younger than 3 year of age undergoing surgical repair of ventricular septal defect (VSD).　We measured Cdyn at surgical incision (Cdyn1), before cardio pulmonary bypass (CPB) (Cdyn2), after weaning from CPB (Cdyn3), before sternal closure (Cdyn4） and after sternal closure (Cdyn5). The following data
were recorded as background factors: age, sex, weight, chromosomal abnormality, pulmonary to systemic flow ratio (Qp/Qs), pulmonary-to-systemic blood pressure ratio (Pp/Ps), mean pulmonary artery pressure (mPAP), duration of CPB, duration of aortic cross-clamp and fluids balance during CPB. P < 0.05 was considered significant. Cdyn5 was significantly higher than Cdyn1. Cdyn2–4 showed significant change and had a tendency to increase in sequence.　Patients with high Qp/Qs and those with high mPAP showed lower improvement in Cdyn between before and after surgery. A multiple regression analysis revealed that mPAP had the significant influence on the improvement of Cdyn.　We conclude that surgical repair of VSD improvers Cdyn, and Cdyn increases with time during open chest surgery, and that improvement of Cdyn may be interrupted among patients with increased pulmonary blood flow and pulmonary hypertension.

肺コンプライアンス

先天性心疾患根治術

肺血流増加

肺体血流比

平均肺動脈圧

respiratory compliance

surgical repair of congenital heart disease

increased pulmonary blood flow

pulmonary to systemic flow ratio

mean pulmonary artery pressure

Medical sciences [ 490 ]

jpn

広島麻酔医学会

[ISSN] 0385-1664

[NCID] AN00232251