CAJ | 학술논문

目的探讨婴幼儿体外循环(CPB)术后肺损害机制及改良超滤肺功能保护效果.方法收集本院先天性心脏病患儿施行手术40例,根据患儿家长意愿是否采用改良超滤分为无改良超滤组(20例)和改良超滤组(20例),患儿家长均签署知情同意书.分别收集转流前及转流后不同时点所测定气道峰压、呼吸停顿压、潮气量、呼吸频率、吸入氧浓度和吸气比例,及所测量动脉血中C3a、C5a及血栓素(TXA2)、白三烯(LT)的浓度.结果两组患儿CPB后肺静态顺应性(Cstat)、氧合指数(OI)较术前降低,肺泡-动脉氧分压(AaDO2)增加(P＜0.05)；在T3、T4、T5时间改良超滤组的Cstat、OI高于无改良超滤组,AaDO2低于无改良超滤组(P＜0.05).C3a、C5a术后浓度立即降低,但两组差异无统计学意义(P＞0.05)；无改良超滤组TXA2、LT浓度术后升高；在T2、T3、T4、T5时点改良超滤组的TXA2、LT低于无改良超滤组(P＜0.05).结论术后肺功能损害可能与CPB术后补体激活及再灌注损伤(L/R)致肺毛细血管内皮损伤有关.血浆补体浓度减低可作为观察炎性反应及组织损害早期指标.改良超滤可通过迅速滤出水份,提高胶体渗透压及降低TXA2、LT浓度达到良好肺保护效果.
목적 탐토영유인체외순배(CPB)술후폐손해궤제급개량초려폐공능보호효과.방법 수집본원선천성심장병환인시행수술40례,근거환인가장의원시부채용개량초려분위무개량초려조(20례)화개량초려조(20례),환인가장균첨서지정동의서.분별수집전류전급전류후불동시점소측정기도봉압、호흡정돈압、조기량、호흡빈솔、흡입양농도화흡기비례,급소측량동맥혈중C3a、C5a급혈전소(TXA2)、백삼희(LT)적농도.결과 량조환인CPB후폐정태순응성(Cstat)、양합지수(OI)교술전강저,폐포-동맥양분압(AaDO2)증가(P＜0.05)；재T3、T4、T5시간개량초려조적Cstat、OI고우무개량초려조,AaDO2저우무개량초려조(P＜0.05).C3a、C5a술후농도립즉강저,단량조차이무통계학의의(P＞0.05)；무개량초려조TXA2、LT농도술후승고；재T2、T3、T4、T5시점개량초려조적TXA2、LT저우무개량초려조(P＜0.05).결론 술후폐공능손해가능여CPB술후보체격활급재관주손상(L/R)치폐모세혈관내피손상유관.혈장보체농도감저가작위관찰염성반응급조직손해조기지표.개량초려가통과신속려출수빈,제고효체삼투압급강저TXA2、LT농도체도량호폐보호효과.
Objective To study the mechanism of pulmonary injury and protective effect of modified ultrafiltration on lung function in infant open heart surgery.Methods According to the wishes of parents,40 cases of congenital heart disease were divided into without modified ultrafiltration control group (C) and modified ultrafiltration group (M),and parents signed informed consent.The cardiopulmonary bypass (CPB) was used without ultrafiltration in Group C,while with modified ultrafiltration in group M.The pneumodynamic parameters and C3a,C5a,TXA2,LT were measured at specific time points.Results The static pulmonary compliance (Cstat) and oxygen index (OI) were lower,and alveolar-arteria oxygen difference (AaDO2) was higher after CPB in the two groups(P ＜ 0.05).At T3,T4 and T5 time points,the Cstat and OI in Group M was higher than that in Group C; AaDO2 in Group M was lower than that in Group C (P ＜0.05).The levels of C3a and C5a were lower after CPB in the two groups; levels of TXA2,LT were higher after CPB in the C groups.At T2,T3,T4 and T5 time points,the TXA2 and LT in Group M were lower than that in Group C(P ＜0.05).Conclusions The pulmonary injury in pediatric open heart surgery may be concerned with the the alexin(C3a,C5a) activation and I/R.The level of C3a and C5a was considered earlier index of inflammatory reaction and pulmonary injury.Modified ultrafiltration improves pulmonary function due to elevating coloid osmotic pressure and degrading the plasma level of TXA2,LT.