| Summary: | 碩士 === 長庚大學 === 臨床醫學研究所 === 99 === Objective: Most of the patients of open sternal cardiac surgery will receive sternum closure immediately after surgery, but for some patients, the closure of sternum may be delayed due to unstable cardiopulmonary condition. Sternal closure after cardiac surgery may cause heart compression and compromise hemodynamics and respiratory mechanics, and necessitate further ventilatory settings adjustment. The aim of our study was to study the serial change of pulmonary mechanics, gas exchange and hemodynamics after delay sternal closure in neonatal cardiac surgery patients.
Design: Prospective observational study.
Setting: Pediatric cardiac surgery intensive care unit, National Taiwan University Hospital.
Patients: Twenty-six neonatal patients (mean age, 44.6 days) after cardic surgery were enrolled in the study. Data were collected from July 2010 till May 2011.
Intervention: Pulmonary mechanics were recorded by the respiratory mechanics monitor, and hemodynamics were collected through Philips physiologic monitor.
Measurements and Main Results: Data was collected 2 hours before (Time 1), 30 minutes before (Time 2), 5 minutes after (Time 3), 30 minutes after (Time 4), 2 hours after sternal closure (Time 5) with the patient paralyzed. Tidal volume, tidal volume/kg, and dynamic compliance significantly decreased after sternal closure, however, FiO2, end tidal CO2, blood pressure, CVP, and HR significantly increased after closure of sternum.
Conclusions: Both the pulmonary mechanics and hemodynamics changes sequentially from baseline opening state to closure of the sternum in neonatal cardiac surgery patients of delayed closure of the sternum. However, the changes recovered 30 minutes later, and the amplitude of changes were clinically acceptable. Adjustment of ventilatory settings immediately after closure of sternum is not necessary.
Key words: neonatal cardiac surgery, delay sternal closure, respiratory mechanics.
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