摘要
目的探讨体外循环下心脏矫治术中吸入地氟醚-NO对先心病合并肺动脉高压患儿肺的保护作用。方法 40例先心病合并肺动脉高压患儿随机分为4组(n=10):对照组(CON组)、地氟醚组(DES组)、NO组(NO组)及地氟醚+NO组(DES+NO组)。DES组在肺动脉导管置入后吸入地氟醚1-1．3MAC直至转流前(约40min),NO组在相同时段吸入10-20 ppm NO,DES+NO组在相同时段吸入地氟醚与10-20 ppm NO。在开胸后5min(T0)、转流前5min(T1)、转流开始后5min(T2)以及手术结束时(T3)各时点分别记录患儿的平均动脉压(MAP)、肺动脉压(PAP)、气道峰压(Ppeak)和呼吸系统总顺应性(Crs),在T0、T3时点分别抽取动脉血测定高铁血红蛋白(MetHb)、血浆可溶性细胞粘附分子(sICAM-1)和丙二醛(MDA)浓度以及黄嘌呤氧化酶(XOD)活性。结果与T0相比,T1-3时NO组和 DES+NO组PAP降低;T3时CON组Ppeak升高,Crs及PaO2降低(P<0．01),DES组PaO2降低但 Ppeak、Crs差异均无统计学意义,NO组和DES+NO组Ppeak、Crs和PaO2差异均无统计学意义。与 CON组相比,T3时NO组和DES+NO组Ppeak降低,Crs及PaO2增高(P<0．05)。与T0相比,T3时 CON组sICAM-1、XOD和MDA水平均升高;T3时DES组、NO组和DES+NO组上述指标均低于CON 组。结论在体外循环下心脏矫治术中,先心病合并肺动脉高压患儿转流前吸入地氟醚与NO,不仅可降低肺动脉压,还可通过抑制全身炎性反应及脂质过氧化反应,减轻肺损伤。
Objective To investigate the effects of desflurane and/or nitric oxide （NO） on the lung injury induced by ischemia-reperfusion （I/R） during cardiopulmonary bypass （CPB） in children with pulmonary hypertension secondary to congenital heart disease （CHD） . Methods Forty children with CHD and pulmonary hypertension （24 male, 16 female） aged 0.6-3.7 yrs weighing 7.1-11.9 kg undergoing cardiac surgery under CPB were randomly divided into 4 groups （n = 10 each） ： group control; group DES; group NO and group DES ＋ NO. The patients were premedieated with oral midazolam 0.5 mg·kg^-1 . Anesthesia was induced and maintained with fentanyl and vecuronium. Radial artery was cannulated for MAP monitoring and blood sampling. Pulmonary catheter was placed under direct vision after chest was opened. The patients received inhalation of desflurane （ 1- 1.3 MAC ） （ group DES）/NO （ 10-20 ppm） （ group NO） /DES ＋ NO （ group DES ＋ NO） immediately after pulmonary catheterization until the start of CPB. MAP, PAP, peak airway pressure （Ppeak） and compliance of respiratory system （Crs） were recorded at 5 min after induction （To）, 5 min before CPB （T0）, 5 min after start of CPB （T2） and at the end of surgery （T3）. Blood samples were taken at To and T3 for determination of metbemoglobin （Met-Hb）, soluble intercellular adhesion molecule-1 （sICAM-1）, XOD and MDA. Results The four groups were comparable with respect to age, M/F ratio, body weight, duration of CPB and type of operation performed. MAP was significantly decreased after inhalation of desflurane alone or desflurane ＋ NO before CPB （at TI ） as compared to the baseline value at To ; while PAP was significantly decreased after inhalation of NO alone or NO ＋ desflurane before CPB （ at T1 ） as compared to the baseline value. Ppeak was significantly lower while Crs was significantly higher at end of surgery （ T3 ） in group NO and NO ＋ desflurane than in control group. Blood sICAM-1 and MDA
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第2期136-139,共4页
Chinese Journal of Anesthesiology
关键词
儿童
心脏缺损
先天性
高血压
肺性
心肺转流术
一氧化氮
地氟醚
Child
Heart defects, congenital
Hypertension, pulmonary
Cardiopulmonary bypass
Nitric oxide
Desflurane
