中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
9期
814-816
,共3页
王文伟%李军%蒋懿斐%倪育飞%张文辉%连庆泉
王文偉%李軍%蔣懿斐%倪育飛%張文輝%連慶泉
왕문위%리군%장의비%예육비%장문휘%련경천
前列地尔%心肺转流术%呼吸窘迫综合征,成人%儿童
前列地爾%心肺轉流術%呼吸窘迫綜閤徵,成人%兒童
전렬지이%심폐전류술%호흡군박종합정,성인%인동
Alprostadil%Cardiopulmonary bypass%Respiratory distress syndrome,adult%Child
目的 评价脂微球化前列地尔对体外循环(CPB)诱发小儿肺损伤的影响.方法 择期CPB下行先天性心脏病矫正术患儿27例,年龄100 d~9岁,体重5~22 kg,心功能Ⅰ或Ⅱ级,随机分为2组:对照组(C组,n=12)和脂微球化前列地尔组(P组,n=15).P组预充液中加入脂微球化前列地尔10 ng/ml,麻醉诱导后即刻经中心静脉输注脂微球化前列地尔10 ng·kg-1·min-1至术毕,C组给予等容量生理盐水.于CPB开始前即刻(T1)、主动脉开放后30 min(T2)、2 h(T3)、6 h(T4)及24 h(T5)时取桡动脉血样,行动脉血气分析及中性粒细胞(PMN)计数,采用酶联免疫吸附法测定血浆白细胞介素6(IL-6)、IL-8、IL-10、肿瘤坏死因子α(TNF-α)和基质金属蛋白酶-9(MMP-9)的浓度;计算动态肺顺应性(Cd)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)及呼吸指数(RI).结果 与C组比较,P组OI升高,RI、A-aDO2、血浆IL-6、IL-8、TNF-α、IL-10、MMP-9浓度及PMN计数降低(P<0.05或0.01).结论 脂微球化前列地尔可减轻CPB诱发的小儿肺损伤,可能与其减轻肺组织炎性反应有关.
目的 評價脂微毬化前列地爾對體外循環(CPB)誘髮小兒肺損傷的影響.方法 擇期CPB下行先天性心髒病矯正術患兒27例,年齡100 d~9歲,體重5~22 kg,心功能Ⅰ或Ⅱ級,隨機分為2組:對照組(C組,n=12)和脂微毬化前列地爾組(P組,n=15).P組預充液中加入脂微毬化前列地爾10 ng/ml,痳醉誘導後即刻經中心靜脈輸註脂微毬化前列地爾10 ng·kg-1·min-1至術畢,C組給予等容量生理鹽水.于CPB開始前即刻(T1)、主動脈開放後30 min(T2)、2 h(T3)、6 h(T4)及24 h(T5)時取橈動脈血樣,行動脈血氣分析及中性粒細胞(PMN)計數,採用酶聯免疫吸附法測定血漿白細胞介素6(IL-6)、IL-8、IL-10、腫瘤壞死因子α(TNF-α)和基質金屬蛋白酶-9(MMP-9)的濃度;計算動態肺順應性(Cd)、氧閤指數(OI)、肺泡-動脈氧分壓差(A-aDO2)及呼吸指數(RI).結果 與C組比較,P組OI升高,RI、A-aDO2、血漿IL-6、IL-8、TNF-α、IL-10、MMP-9濃度及PMN計數降低(P<0.05或0.01).結論 脂微毬化前列地爾可減輕CPB誘髮的小兒肺損傷,可能與其減輕肺組織炎性反應有關.
목적 평개지미구화전렬지이대체외순배(CPB)유발소인폐손상적영향.방법 택기CPB하행선천성심장병교정술환인27례,년령100 d~9세,체중5~22 kg,심공능Ⅰ혹Ⅱ급,수궤분위2조:대조조(C조,n=12)화지미구화전렬지이조(P조,n=15).P조예충액중가입지미구화전렬지이10 ng/ml,마취유도후즉각경중심정맥수주지미구화전렬지이10 ng·kg-1·min-1지술필,C조급여등용량생리염수.우CPB개시전즉각(T1)、주동맥개방후30 min(T2)、2 h(T3)、6 h(T4)급24 h(T5)시취뇨동맥혈양,행동맥혈기분석급중성립세포(PMN)계수,채용매련면역흡부법측정혈장백세포개소6(IL-6)、IL-8、IL-10、종류배사인자α(TNF-α)화기질금속단백매-9(MMP-9)적농도;계산동태폐순응성(Cd)、양합지수(OI)、폐포-동맥양분압차(A-aDO2)급호흡지수(RI).결과 여C조비교,P조OI승고,RI、A-aDO2、혈장IL-6、IL-8、TNF-α、IL-10、MMP-9농도급PMN계수강저(P<0.05혹0.01).결론 지미구화전렬지이가감경CPB유발적소인폐손상,가능여기감경폐조직염성반응유관.
Objective To investigate the effects of lipo-alprostadil on lung injury induced by cardiopulmonary bypass (CPB) in children. Methods Twenty-seven ASA Ⅰ or Ⅱ children aged 100 d-9 yr weighing 5-22 kg undergoing elective cardiac surgery under CPB were randomly divided into 2 groups: control group (C, n=12) and lipo-alprostadil group (P, n=15). In group P lipo-alprostadil 10 ng/ml was added to the priming solution and infused via CVP line at 10 ng·kg-1·min-1 immediately after induction of anesthesia until the end of operation. Group C received equal volume of normal saline instead of lipo-alprostadil. Blood samples were obtained from radial artery immediately before CPB (T1), at 30 min (T2), 2 h (T3), 6 h (T4) and 24 h (T5) after aortic unclamping for blood gas analysis, PMN count and determination of plasma IL-6, IL-8, IL-10, TNF-α and MMP-9 concentrations (by ELISA). Alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (OI), dynamic lung compliance (Cd) and respiratory index (RI) were calculated. Results OI was significantly higher while RI, A-aDO2, the plasma concentrations of IL-6, IL-8, TNF-α, IL-10, MMP-9 and PMN count were lower in group P than in group C. Conclusion Lipo-alprostadil can ameliorate lung injury induced by CPB in children by reducing inflammatory response of the lung tissue.