麻酔と蘇生 Volume 55 Issue 1
published_at 2019-03-01

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
fulltext
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AnesthResus_55-1_21.pdf
Abstract
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。
Abstract
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.
Descriptions
本稿の要旨は,日本心臓血管麻酔学会第22回学術大会(2017年,栃木),藤田昌雄賞候補セッションで発表した。
Keywords
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