CAJ | 학술논문

目的观察前列地尔和(或)乌司他丁(Ulinastatin)对小儿体外循环后炎性反应的影响及其肺保护作用.方法选择择期行体外循环下房室缺修补术患儿58例.随机分为4组:对照组(C组14例)、前列地尔组(P组15例)、乌司他丁组(U组15例)、前列地尔联合鸟司他丁组(PU组14例).观察患儿血流动力学变化,总机械通气时间和ICU留治时间.麻醉诱导后CPB前(T、)、主动脉开放30 min(T2)、2 h(T3)、6 h(T4)、24 h(T5)5个时点采集桡动脉血测最中性粒细胞(PMN),血浆中白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子(TNF)-α和基质金属蛋白酶-9(MMP-9)的含量.于T1、T2、T2记录吸入氧浓度和动脉血气计算肺泡氧合指数(OI).结果与C组比较,其他3组在T2、T3时PMN、IL-6、IL-8、TNF-α的水平明显降低(均P<0.05),其中PU组最低.U组、PU组患儿血浆IL-10水平在T2、T3明显高于C组,而MMP-9水平明显低于C组(均P<0.05),P组则与C组差异无统计学意义.在T2时其他3组OI值明显高于C组(均P<0.05).PU组机械通气时间明显短于C组(P<0.05).结论 CPB中同时使用前列地尔和乌司他丁可减轻体外循环后炎性反应从而保护肺功能.
목적 관찰전렬지이화(혹)오사타정(Ulinastatin)대소인체외순배후염성반응적영향급기폐보호작용.방법 선택택기행체외순배하방실결수보술환인58례.수궤분위4조:대조조(C조14례)、전렬지이조(P조15례)、오사타정조(U조15례)、전렬지이연합조사타정조(PU조14례).관찰환인혈류동역학변화,총궤계통기시간화ICU류치시간.마취유도후CPB전(T、)、주동맥개방30 min(T2)、2 h(T3)、6 h(T4)、24 h(T5)5개시점채집뇨동맥혈측최중성립세포(PMN),혈장중백세포개소(IL)-6、IL-8、IL-10、종류배사인자(TNF)-α화기질금속단백매-9(MMP-9)적함량.우T1、T2、T2기록흡입양농도화동맥혈기계산폐포양합지수(OI).결과 여C조비교,기타3조재T2、T3시PMN、IL-6、IL-8、TNF-α적수평명현강저(균P<0.05),기중PU조최저.U조、PU조환인혈장IL-10수평재T2、T3명현고우C조,이MMP-9수평명현저우C조(균P<0.05),P조칙여C조차이무통계학의의.재T2시기타3조OI치명현고우C조(균P<0.05).PU조궤계통기시간명현단우C조(P<0.05).결론 CPB중동시사용전렬지이화오사타정가감경체외순배후염성반응종이보호폐공능.
Objective To investigate the therapeutic effects of alprostadil (Lipo-PGE1) and Ulinastatin on inflammatory response and lung injury after cardiopulmonary bypass (CPB) in pediatric patients with congenital heart diseases. Methods 58 children with congenital heart diseases, including atrial septal defect,ventricular septal defect, and atrioventricular septal defect, scheduled to undergo CPB,aged 4-72 months, were randomly divided into 4 groups: alprostadil Group P (n = 15) receiving alprostadil central vein until the end of operation, Group U (n = 15) receiving ulinastatin 20 000 U/kg divided into several doses to be added into the prime solution, Group PU (n = 14) receiving alprostadil and ulinastatin according to the above protocols, and Group C (control group, n = 14) receiving normal saline of the equal volume. Electrocardiogram (ECG) ,heart rate (HR),pulse oxygen saturation (SpO2), and mean arterial pressure (MAP) were continuously monitored during operation. Duration of mechanical ventilation and staying in ICU were also recorded. Plasma neutrophil (PMN), IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMP-9) levels in the radial arterial blood samples were measured after induction of anesthesia before CPB (T1),30 minutes and (T2),2 hours (T3),6 hours (T4), and 24 hours (T5) after the declamping of aorta. Inhaled oxygen concentration and arterial blood gas analysis were recorded at T1 ,T2 , and T3 for calculation of oxygenation index (OI). Results There were no significant differences in the MAP and HR among these four groups at any time points (all P > 0.05). The umbers of PMN and the levels of IL-6, IL-8, and TNF-α at T2 and T3 of Groups P,U, and PU were all significantly lower than that of Group C (all P < 0.05), with those of Group PU being the lowest. The IL-10 levels at T2 and T3 of Groups U and PU were significantly higher than that of Group C (both P < 0.05), the level of MMP-9 at T2 and T3 of Groups U and PU were significantly lower than that of Group C (all P < 0.05),however, there was not significant difference between Group P and Group C (P >0.05). The Ols at T2 of Groups P, U, and PU were significantly higher than that of Group C (all P < 0.05). The mechanical ventilation time of Groups P, U, and PU were all significantly shorter than that of Group C, and that of Group PU was significantly shorter than that of group C (P < 0.05). Conclusion Decreasing the inflammatory response after CPB, alprostadil and ulinastatin used during CPB effectively reduce the pulmonary injury via inhibition of the neutrophil activation and cytokines release.