摘要
目的 评价在先心病伴肺动脉高压患儿心肺转流术期间，从肺动脉灌注含乌司他丁的低温肺保护液对肺脏的保护作用。方法选择2005—09—2006—12浙江大学医学院附属儿童医院心胸外科收治的左向右分流先心病伴中重度肺动脉高压的患儿54例，中重度肺动脉高压以肺动脉收缩压／体循环收缩压〉0．45为标准，手术前有感染征像（白细胞〉12000／μL，体温〉38℃，C-反应蛋白〉8mg／L）、过敏史者除外。采用抽签法随机分为三组，各18例，A组为对照组（术中未给予肺保护液），B组在术中经肺动脉灌注不含乌司他丁的低温肺保护液，C组在术中经肺动脉灌注含乌司他丁的低温肺保护液。在开胸后及回ICU后0h，3h，6h，24h（T1-5）五个时点抽取桡动脉血样，测定血浆丙二醛（MDA）、髓过氧化物酶（MPO）浓度；在T1-4计算肺泡-动脉氧分压差（A-aDO2）、肺动态顺应性（Cd）。记录呼吸机辅助通气时间。采用SPSS12．0统计软件对计量指标进行统计分析，资料以均数±标准差（x±s）表示，组间比较用单因素方差分析，组间两两比较用LSD法检验，以P〈0．05为差异具有统计学意义。结果三组患儿回ICU后各时点（BT1-5）MDA、MPO值均较T1升高；与A组相比：B组在T4时点MDA、MPO[分别为（7．66±1．42）pg／mL，（194．2±35．41）U／L]显著降低（P〈0．05），组C在B—B时点MDA[分别为（5．37±1．01）pg/mL，（7．52±0．98）pg／mL，（6．22±0．83）pg／mL]及在T4时点MPO（184．2±35．41）U／L均显著降低；两干预组（B组和C组）各时间点MDA和MPO差异无统计学意义。三组术后A—aD02升高；与A组相比：B组与C组在T3,T4时点小，但C组在T4时点A—aDO2（72．9±23．94）mmHg较组B（89．2±24．28）mmHg低，差异具有统计学意义。三组术后Cd降低；与A组相比：B组在B时点[（0．57±0．16）mL·cmH2O^-1·kg^-1]、C组在T3和T4�
Objective To evaluate protective effects of hypothermic pulmonary protective solution with ulinastatin on lung function during cardiopulmonary bypass （CPB） in the patients with congenital heart disease（CHD） and pulmonary hypertension. Method Fifty-four children, who had CHD of left-to-right shunts with moderate-serious pulmonary hypertension, were enrolled. They had been performed with the radical operation under CPB from September 2005 to December 2006 in the Department of Cardiovascular Surgery, Children＇ s Hospital of Zhejiang University. Moderate-serious pulmonary hypertension was defined as pulmonary-to-systolic pressure ratio 〉 0.45 （Pp/Ps 〉 0.45）. Fifty-four children were randomly divided into three groups. Patients in group A （n = 18） didn＇t receive pulmonary protective solution, and served as control; patients in group B （n =18） were administered with pulmonaryy protective solution without ulinastatin; patients in group C （n = 18） were administered with pulmonary protective solution with ulinastatin. The sewJn concentrations of MDA and MPO were measured at five different time points：pre-operation, 0 h, 3 h, 6 h and 24 h in the intensive care anit （ICU） （T/-5）- Patients＇ lung functions were monitored at T1 - T4. Tile time of mechanical ventilation was recorded. Results No one died in this study. The mean time of mechanical ventilation was shorter in the group B and group C than that in the group A. The MDA and MPO levels were lower in group B compared with group A at T4. The MDA level at T3 - T5 and the MPO level at T4 was lower in group C than those in group A. There were no significant in MDA and MPO levels between group B and group C at five time point. A-aDO2 was lower in groups B and C than those in group A at T3 and T4, whereas at T4, A-aDO2 was lower in group C than that in group B. Cdyn was higher in group B at T3 and group C at T3 - T4 than those in group A. Cdyn was lower in groups C than that in group B at T4. Conclusions Lung peffusion with hypother
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2009年第6期594-597,共4页
Chinese Journal of Emergency Medicine
关键词
乌司他丁
心肺转流术
肺保护
先天性心脏病
Ulinastatin
Cardiopulmonary bypass
Lung protection
Congenital heart disease
