摘要
目的 研究比较深低温停循环(DHCA)和深低温低流量(DHLF)对先心病婴儿肺功能及肺表面活性物质(PS)活性水平的影响。方法 20例室间隔缺损伴肺动脉高压婴儿,根据行心肺转流(CPB)方法的不同,随机平均分为DHCA组和DHLF组。分别测定两组CPB前,CPB后5min,CPB后2h的肺静态顺应性、肺气道阻力、呼吸指数及饱和卵磷脂/总磷脂(SatPC/APL)和饱和卵磷脂/总蛋白(SatPC/TP)值。结果 CPB后5min和CPB后2h,两组的肺静态顺应性都较CPB前明显降低(P均<0.01);肺气道阻力和呼吸指数都明显升高(P均<0.01)。CPB后2hDHLF组肺静态顺应性下降的幅度和呼吸指数增加的幅度都明显大于DHCA组(P均<0.01)。CPB后5min和CPB后2h,二组的SatPC/TPL和SatPC/TP都较CPB前明显降低(P均<0.01)。CPB后5min,DHLF组Sat-PC/TPL下降的幅度明显大于DHCA组(P<0.05);CPB后2h,DHLF组SatPC/TPL和SatPC/TP下降的幅度都明显大于DHCA组(P均<0.01)。DHLF组术后ICU滞留时间明显高于DHCA组(P<0.05)。结论 DHCA和DHLF都能明显引起先心病婴儿肺功能受损及PS活性水平的下降,但DHLF较DHCA对肺的损伤更为严重。
Objective To compare the effects of deep hypothermia circulatory arrest (DHCA) with
deep hypothermic low-flow cardiopulmonary bypass (DHLF) on pulmonary surfactant (PS) activity in in-
fants with congenital heart disease. Methods Twenty infants (male 11 ,female 9) with ventricular septum
defect and pulmonary hypertension were randomly and averagely divided into DHCA or DHLF group. Their
age ranged 4 ～ 15 mon and weight ranged 4.5 ～ 8.5 kg. The SatPC/TPL (saturated phosphatidylcholine/
total phospholipids), SatPC/TP(saturated phosphatidylcholine/total protein) and static pulmonary compli-
ance were measured before, 5 minutes and 2 hours after CPB. Results The length of ICU stay of DHLA
group was significantly longer (P < 0.05) than that of DHCA group. Compared with the preoperative in-
dex, a decreased pulmonary compliance could be noted in both groups after discontinuation of CPB. Howev-
er, the pulmonary compliance in DHLF group was lower than that in DHCA group after 2 hours of discon-
tinuation of CPB(P < 0.01). Meanwhile, the decreased SatPC/TPL and SatPC/TP could be observed on
both groups after weaned from CPB. SatPC/TPL in DHLF group was lower than that in DHCA group af-
ter 5 minutes of discontinuation of CPB(P < 0.05), and SatPC/TP in DHLF group was also lower than
that in DHCA group after 2 hours of discontinuation of CPB(P < 0.01). Conclusion DHLF could lead to
decline of pulmonary surfactant activity level significantly than that of DHCA in infants with congenital
heart disease.
出处
《中华小儿外科杂志》
CSCD
北大核心
2003年第6期510-512,共3页
Chinese Journal of Pediatric Surgery
