体外循环中含氧血持续肺动脉灌注的肺保护作用

Lung protection of continuous pulmonary artery perfusion with oxygenated blood during cardiopulmonary bypass

目的:探讨体外循环(CPB)期间含氧血持续肺动脉灌注对心脏瓣膜置换患者的肺保护作用。方法:30例行二尖瓣置换术患者随机分为肺灌注组(n=15),对照组(n=15)。肺灌注组患者CPB术中采用含氧血肺动脉持续灌注,对照组常规行二尖瓣置换术,未行肺动脉灌注。记录CPB时间、主动脉阻断时间、术后呼吸机辅助时间、ICU监护时间。分别于术前、CPB结束及术后0,6h测算氧合指数、肺静态顺应性变化。CPB停机后30min,取患者右上肺组织,观察组织形态学变化。结果:肺灌注组患者术后呼吸机辅助时间及ICU监护时间短于对照组(P<0.05)。肺灌注组患者CPB结束和术后0,6h的氧合指数及肺静态顺应性高于对照组(P<0.05)。肺组织活检病理结果显示,对照组肺间质水肿明显,肺间质大量炎性细胞浸润,肺灌注组无明显病理改变。结论:CPB术后存在肺损伤,CPB中含氧血持续肺动脉灌注可减轻肺损伤。

Objective To determine the lung protection of continuous pulmonary artery perfusion with oxygenated blood during cardiopulmonary bypass （CPB）. Methods Thirty patients undergoing mitral valve replacement were randomly divided into the control group （n=15） and the lung perfusion group （n=15）. The patients in the lung perfusion group were perfused oxygenated blood continuously to the pulmonary artery during CPB. The patients in the control group were performed the routine procedure of mitral valve replacement. Record the CPB time, aortic cross-clamp time, mechanical ventilation time and ICU monitoring time. The patients＇ oxygen index （OI） and lung static compliance （Cstat） were measured before the surgery, at 0 h after the CPB and at 0, 6 h after the surgery. Right lung biopsy spec- imens were obtained at 30 rain after the CPB to observe the histological changes. Results The mechani- cal ventilation time and ICU monitoring time were shorter in the lung perfusion group than those in the control group （P〈0.05）. The patients＇ OI and Cstat were higher after surgery in the lung perfusion group than＇those in the control group （P〈0.05）. Tissue examination showed lung parenchyma edema and inflammatory cells accumulated in the control group, while no remarkable pathological changes occurred in the lung perfusion group. Conclusion Lung injury exists after the surgery by CPB. Continuous pulmonary artery perfusion with oxygenated blood during CPB can decrease the lung injury.