缺血后处理对法洛四联症患儿的心肺保护作用

Cardiopulmonary protection of ischemic postconditioning in cardiac surgery in children with tetralogy of Fallot

目的缺血后处理能减轻缺血、再灌注损伤,但在心脏外科手术中的效果尚缺乏大组病例报道。该研究观察了缺血后处理对法洛四联症患儿的心肺保护作用。方法将105例法洛四联症根治术患者随机分为常规组和处理组,常规组行常规手术,处理组给予缺血后处理,即间断夹闭升主动脉3次。术后以两组患者的ICU治疗时间、输血量、正性肌力药物评分、血流动力学、呼吸功能以及乳酸代谢作为评价指标。结果与常规组比较,处理组ICU治疗时间明显缩短[(37±21)h vs(54±26)h],输血量及正性肌力药物计分明显减少[(308±230)mLvs(526±515)mL和(5.9±5.0)vs(10.3±7.7)],血流动力学和呼吸功能恢复更好,乳酸蓄积明显减少。结论缺血后处理对法洛四联症根治术患儿有心肺保护作用。

Objective Ischemic postconditioning effectively minimizes the ischemic/reperfusion injury, and the large series of case reports on its protective effects in cardiac surgery are limited. A randomized trial was conducted to investigate the effect of ischemic postconditioning on eardiopulmonary protection in children undergoing cardiac surgery for tetralogy of Fallot. Methods One hundred and five children with tetralogy of Fallot undergoing surgery were randomly assigned to control （n = 58 ） and isehemic postconditioning groups （n = 47 ）. Ischemic postconditioning was performed by intermittent aortic clamping after reperfusion. After surgery, the duration of intensive care unit （ ICU ） stay, capacity of blood transfusion, hemodynamics, inotropic scores, respiratory function, and release of blood lactate were assayed. Results There was a significant decrease in the ICU stay in the posteonditioned group compared with the control group （37 ± 21 hrs vs 54 ±26 hrs; P 〈 0.05 ）. The capacity of blood transfusion （308 ± 230 mL vs 526 ± 515 mL; P 〈 0.05） and the inotropie scores （5.9± 5.0 vs 10.3± 7.7; P 〈 0. 05 ） in the postconditioned group were significantly reduced compared with those in the control group. Blood lactate contents in the postconditioned group was significantly lower that those in the control group 1, 3, 6, 9, 12 and 20 hrs after surgery. The postconditioned group showed more improved hemodynamics and respiratory function than the control group. Conclusions Ischemic postconditioning may provide clinical benefits with respects to myocardial and pulmonary protections in children undergoing repair for tetralogy of Fallot.