CAJ | 학술논문

目的：研究右美托咪定对体外循环（ CPB）下心内直视手术患儿肺功能的保护作用。方法择期行心脏室间隔缺损修补术患儿30例，年龄7个月～3岁，体重7～18 kg，随机均分为右美托咪定组（ D组）和对照组（ C组）。麻醉诱导气管插管后，D组给予初始剂量0．5μg/kg的右美托咪定（给药时间大于10 min），继之以0．5μg/（ kg·h）的速度维持直至手术结束， C组给予相同容量的生理盐水。分别于给药前（ T0）、停CPB后2 h（ T1）、6 h（ T2）及12 h（ T3）采集桡动脉样血，测定血浆肿瘤坏死因子-α（ TNF-α）、白介素（ IL）-6的浓度，并进行血气分析，计算呼吸指数（ RI）、氧合指数（ OI）和肺顺应性（ CL）。结果T1～T3时D组 TNF-α、IL-6的浓度和RI明显低于C组、OI明显高于C组（ P＜0．05）。 C组CLT1低于T0且低于D组。结论右美托咪定可通过抑制CPB的炎性反应改善CPB下心内直视手术患儿的肺功能。
목적：연구우미탁미정대체외순배（ CPB）하심내직시수술환인폐공능적보호작용。방법택기행심장실간격결손수보술환인30례，년령7개월～3세，체중7～18 kg，수궤균분위우미탁미정조（ D조）화대조조（ C조）。마취유도기관삽관후，D조급여초시제량0．5μg/kg적우미탁미정（급약시간대우10 min），계지이0．5μg/（ kg·h）적속도유지직지수술결속， C조급여상동용량적생리염수。분별우급약전（ T0）、정CPB후2 h（ T1）、6 h（ T2）급12 h（ T3）채집뇨동맥양혈，측정혈장종류배사인자-α（ TNF-α）、백개소（ IL）-6적농도，병진행혈기분석，계산호흡지수（ RI）、양합지수（ OI）화폐순응성（ CL）。결과T1～T3시D조 TNF-α、IL-6적농도화RI명현저우C조、OI명현고우C조（ P＜0．05）。 C조CLT1저우T0차저우D조。결론우미탁미정가통과억제CPB적염성반응개선CPB하심내직시수술환인적폐공능。
Objective To investigate the effect of dexmedetomidine on pulmonary function in children undergoing cardiac sur-gery under cardiopulmonary bypass ( CPB) . Methods Thirty patients, aged 7 months-3 years old, weighed 7-18 kg, undergoing re-pair of ventricular septal defect (VSD) under CPB, were randomly divided into dexmedetomidine group (group D) or control group (group C).After intubation, patients in group D received an initial bolus dose of dexmedetomidine (0.5μg/kg) over 10 minutes, im-mediately followed by a continuous infusion of 0.5μg/( kg·h) until the end of the operation. The equal volume normal saline was giv-en instead of dexmedetomidine in group C.Blood sample were collected before injection (T0), at 2 h (T1), 6 h (T2), 12 h (T3) af-ter termination of CPB for determination of serum TNF-α, IL-6 and blood gas analysis. Respiratory index (RI), oxygenation index ( OI) and lung compliance ( CL) of all patients were also calculated. Results The serum concentration of TNF-α, IL-6 and RI were significantly lower while OI was significantly higher at T1, T2, T3 in group D than those in group C. CL was significantly lower at T1 in group C than that at T0 and than that in group D. Conclusion Dexmedetomidine can improve pulmonary function in children under-going cardiac surgery by CPB through inhibiting inflammatory response.