吸入一氧化氮对婴幼儿体外循环中肺功能的影响

Effects of inhale low does nitric oxide on pulmonary function during cardiopulmonary bypass in infants

目的探讨吸入一氧化氮(Nitric oxide,NO)对婴幼儿体外循环手术中肺功能的影响。方法将30例患室间隔缺损的婴幼儿随机分为对照组和NO组,NO组在体外循环期间吸入40 ppm NO直至关胸。体外循环前和术后气管插管未拔前0-1h、1-2h、2-3h测定气道压、吸入氧浓度和呼气末二氧化碳浓度(ETCO2),并分别在同时点采动脉血进行血气分析,计算肺泡死腔率(VD/VT)肺、泡动脉血氧分压差(P(A-a)O2)、动脉血氧含量(CaO2)和肺泡氧合指数(OI),记录术后呼吸机支持时间。体外循环前、主动脉开放后1、5、10min分别取右上肺静脉血和右心房血用于测定丙二醛(MDA)、超氧化物歧化酶(SOD)。结果与NO组相比,对照组再灌注后VD/VT、P(A-a)O2,OI明显升高(P<0.05),CaO2下降(P<0.01);MDA明显升高(P<0.05);SOD明显降低(P<0.01)。结论婴幼儿体外循环术中存在明显肺损害,表现为一些亚临床性肺功能损伤。吸入40 ppm NO对体外循环期间肺功能有保护作用。

Objective： To study the effects of inhale Nitric Oxide （NO） on pulmonary function during cardiopulmonary bypass in infants . Methods ： Thirty infants with congenital heart disease were randomly divided into two groups ： control group （ n = 15 ） and NO group （ n = 15 ）. Before CPB and 0 - 1 h, 1 - 2h, 2 - 3h after operation, the cases of NO group had been inhaled 40 ppm NO till the operation finished. We monitored the following： mean pulmonary arterial pressure （MPAP）, fractional concentration of inspired oxygen （FiO2） , End- tidal CO2 （ET- CO2 ）, the value of volume of dead air space/ tidal volume （VD/VT） , Oxygen Index （OI）, alveolar - arterial PO2 difference （ P （ A - a） O2 ） and Oxygen content in arterial blood （ CaO2 ） were calculated to evaluating pulmonary function, The level of MDA, SOD were observed from right superior pulmonary vein and right atrium before CPB , at 1, 3, 5, 10min after aortic deelamping. Results： The VD/VT, P （A -a） 02, OI in control group were much higher than those in NO group after reperfusion and the CaO2 were lower than that ; MDA were lower than those in control group, and the SOD was higher than that. Conclusion ： Lung ischemia - reperfusion injury was obviously during cardiopulmonary bypass in infants, and manifested itself in sub - clinical pulmonary function injury; Inhale 40ppm NO has protective effects on lung injury during CPB in infants.