中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2010年
4期
252-255
,共4页
法洛氏四联症%心肺转流术%肺%再灌注损伤%灌注,局部%乌司他丁
法洛氏四聯癥%心肺轉流術%肺%再灌註損傷%灌註,跼部%烏司他丁
법락씨사련증%심폐전류술%폐%재관주손상%관주,국부%오사타정
Tetralogy of Fallot%Cardiopulmonary bypass%Lung%Reperfusion injury%Perfusion,regional%Ulinastatin
目的 探讨含乌司他丁(UTI)的低温肺保护液对婴幼儿法洛四联症体外循环肺内炎性反应的保护作用.方法 30例行法洛四联症(TOF)根治术病婴,随机分为肺保护组和对照组,各15例.术前有感染征象(白细胞>12×109/L、体温>38℃,C-反应蛋白>8 mg/L)、有过敏史者除外.肺保护组心脏停跳同时肺动脉灌注低温肺保护液,对照组常规行TOF根治术.围术期监测血浆肿瘤坏死因子(TNF-α)、中性粒细胞CD11b的表达和髓过氧化物酶(MPO),同时监测血气、肺功能及临床指标.结果 血清TNF-α水平肺保护组较对照组低,关胸后0、3 h差异有统计学意义,(11.15±2.47)pg/ml对(14.21±5.55)pg/ml、(12.01±2.69)pg/ml对(15.94±4.86)pg/ml.肺保护组新鲜全血中性粒细胞表面的CD11b平均荧光强度(MFI)水平关胸后3、6 h显著低于对照组,(126.23±36.05)对(156.98±48.34)、(137.27±38.85)对(173.27±67.43).肺保护组MPO水平关胸后3、6、24 h显著低于对照组,(156.52±17.57)U/L对(178.45±35.68)U/L、(178.28±23.63)U/L对(224.66±49.66)U/L、(130.52±57.50)U/L对(96.50±14.49)U/L.肺保护组呼吸机辅助时间明显较对照组短,(17.60±6.39)h对(23.70±8.51)h.肺保护组肺泡-动脉氧阶差(A-aDO2)在关胸后3、6 h显著低于对照组(120.92±33.08)mm Hg(1 mm Hg=0.133 kPa)对(145.52±39.38)mm Hg、(74.76±40.16)mm Hg对(112.50±44.16)mm Hg.肺动态顺应性(Cdyn)在关胸后3、6 h肺保护组显著高于对照组(0.59±0.11)ml·cmH2O-1·kg-1对(0.46±0.17)ml·cmH2O-1·kg-1、(0.67±0.09)ml·cmH2O-1·kg-1对(0.53±0.18)ml·cmH2O-1·kg-1.结论 肺动脉灌注含乌司他丁的低温肺保护液明显减轻体外循环术后肺的炎性反应,具有肺保护作用.
目的 探討含烏司他丁(UTI)的低溫肺保護液對嬰幼兒法洛四聯癥體外循環肺內炎性反應的保護作用.方法 30例行法洛四聯癥(TOF)根治術病嬰,隨機分為肺保護組和對照組,各15例.術前有感染徵象(白細胞>12×109/L、體溫>38℃,C-反應蛋白>8 mg/L)、有過敏史者除外.肺保護組心髒停跳同時肺動脈灌註低溫肺保護液,對照組常規行TOF根治術.圍術期鑑測血漿腫瘤壞死因子(TNF-α)、中性粒細胞CD11b的錶達和髓過氧化物酶(MPO),同時鑑測血氣、肺功能及臨床指標.結果 血清TNF-α水平肺保護組較對照組低,關胸後0、3 h差異有統計學意義,(11.15±2.47)pg/ml對(14.21±5.55)pg/ml、(12.01±2.69)pg/ml對(15.94±4.86)pg/ml.肺保護組新鮮全血中性粒細胞錶麵的CD11b平均熒光彊度(MFI)水平關胸後3、6 h顯著低于對照組,(126.23±36.05)對(156.98±48.34)、(137.27±38.85)對(173.27±67.43).肺保護組MPO水平關胸後3、6、24 h顯著低于對照組,(156.52±17.57)U/L對(178.45±35.68)U/L、(178.28±23.63)U/L對(224.66±49.66)U/L、(130.52±57.50)U/L對(96.50±14.49)U/L.肺保護組呼吸機輔助時間明顯較對照組短,(17.60±6.39)h對(23.70±8.51)h.肺保護組肺泡-動脈氧階差(A-aDO2)在關胸後3、6 h顯著低于對照組(120.92±33.08)mm Hg(1 mm Hg=0.133 kPa)對(145.52±39.38)mm Hg、(74.76±40.16)mm Hg對(112.50±44.16)mm Hg.肺動態順應性(Cdyn)在關胸後3、6 h肺保護組顯著高于對照組(0.59±0.11)ml·cmH2O-1·kg-1對(0.46±0.17)ml·cmH2O-1·kg-1、(0.67±0.09)ml·cmH2O-1·kg-1對(0.53±0.18)ml·cmH2O-1·kg-1.結論 肺動脈灌註含烏司他丁的低溫肺保護液明顯減輕體外循環術後肺的炎性反應,具有肺保護作用.
목적 탐토함오사타정(UTI)적저온폐보호액대영유인법락사련증체외순배폐내염성반응적보호작용.방법 30례행법락사련증(TOF)근치술병영,수궤분위폐보호조화대조조,각15례.술전유감염정상(백세포>12×109/L、체온>38℃,C-반응단백>8 mg/L)、유과민사자제외.폐보호조심장정도동시폐동맥관주저온폐보호액,대조조상규행TOF근치술.위술기감측혈장종류배사인자(TNF-α)、중성립세포CD11b적표체화수과양화물매(MPO),동시감측혈기、폐공능급림상지표.결과 혈청TNF-α수평폐보호조교대조조저,관흉후0、3 h차이유통계학의의,(11.15±2.47)pg/ml대(14.21±5.55)pg/ml、(12.01±2.69)pg/ml대(15.94±4.86)pg/ml.폐보호조신선전혈중성립세포표면적CD11b평균형광강도(MFI)수평관흉후3、6 h현저저우대조조,(126.23±36.05)대(156.98±48.34)、(137.27±38.85)대(173.27±67.43).폐보호조MPO수평관흉후3、6、24 h현저저우대조조,(156.52±17.57)U/L대(178.45±35.68)U/L、(178.28±23.63)U/L대(224.66±49.66)U/L、(130.52±57.50)U/L대(96.50±14.49)U/L.폐보호조호흡궤보조시간명현교대조조단,(17.60±6.39)h대(23.70±8.51)h.폐보호조폐포-동맥양계차(A-aDO2)재관흉후3、6 h현저저우대조조(120.92±33.08)mm Hg(1 mm Hg=0.133 kPa)대(145.52±39.38)mm Hg、(74.76±40.16)mm Hg대(112.50±44.16)mm Hg.폐동태순응성(Cdyn)재관흉후3、6 h폐보호조현저고우대조조(0.59±0.11)ml·cmH2O-1·kg-1대(0.46±0.17)ml·cmH2O-1·kg-1、(0.67±0.09)ml·cmH2O-1·kg-1대(0.53±0.18)ml·cmH2O-1·kg-1.결론 폐동맥관주함오사타정적저온폐보호액명현감경체외순배술후폐적염성반응,구유폐보호작용.
Objective The incidence of acute pulmonary injury occurred after cardiopulmonary bypass for fallot tetrad has been high. The severity of pulmonary ischemia-reperfusion has been found to be reduced with ulinastatin (UTI) in the animal models and clinical practice. We evaluated the effect of pulmonary artery perfusion with a hypothermic protective solution containing ulinastatin on the inflammatory response in the lung during cardiopulmonary bypass. Methods 30 children with tetralogy of Fallot (TOF) were randomly assigned into control group and protective group, 15 cases in each group. Patients would be excluded if they had signs of infections, such as the white blood cell count was over 12000 per microliter, the temperature was above 38 centi-degree and the c-reaction protein was more than 8 mg/L. Operation with routine approaches was performed in the control group and the pulmonary artery was infused with 4℃ protective solution in the protective group while the heart stoped beating. Plasma tumor necrosis factor α (TNF-α) 、CD11b and Myeloperoxidase (MPO) were measured intraoperatively and postoperatively. Blood gas、pulmonary function and clinic index of the patients were also monitored. Results The level of TNF-α was lower in the protective group as compared with that in the control group immediately and 3 hours after closing the sternum [(11.15±2.47) pg/ml vs. (14.21 ±5.55) pg/ml, P<0.05; (12.01 ±2.69) pg/ml vs. (15.94 ±4.86)pg/ml,P <0.01]. The MFI of CD11b was lower in the protective group as compared with that in the control group at 3 and 6 hoursafter closing the sternum (126.23±36.05 vs. 156.98±48.34, P<0.05; 137.27±38.85 vs. 173.27±67.43, P<0.05). The level of MPO was lower in protective group as compared with that in the control group at 3 hours, 6 hours and 24hours after closing the sternum [(156.52±17.57)U/L vs.(178.45±35.68)U/L, P<0.05; (178.28±23.63) U/L vs.(224.66±49.66)U/L, P<0.01;(130.52±57.50)U/L vs. (96.50±14.49)U/L, P<0.05]. The duration of mechanical ventilation was significantly shorter in the protective group than that in the control group (17.60±6.39 vs. 23.70±8.51,P<0.05). Alveolar-arterial oxygen pressure difference (A-aDO2, calculated as [FiO2×713-5/4×PaCO2]-PaO2) in the protective group was less than that in the control group at 3 and 6 hours after closing the sternum [(120.92±33.08)mm Hg vs. (145.52±39.38)mmHg, P<0.05;(74.76±40.16)mm Hg vs. (112.50±44.16)mmHg, P<0.01]. Dynamic compliance (Cdyn) in protective group was lower than that in control group at 3 and 6 hours after closing the sternum [(0.59±0.11)ml·cmH2O-1·kg-1 vs. (0.46±0.17)ml·cmH2O-1·kg-1, P<0.05;(0.67±0.09)ml·cmH2O-1·kg-1vs. (0.53±0.18)ml·cmH2O-1·kg-1,P<0.05). Conclusion Perfusion with hypothermic protective solution containing UTI to the pulmonary artery during cardiopulmonary bypass may reduce the inflammatory responses substantially in the lung after bypass and had a role in the lung protection.
