低温保护液肺动脉灌注对右腋下小切口心内直视术的肺保护作用

Protective effect of hypothermal pulmonary artery perfusion on lungs during intracardiac operation via right subaxillary small incision

目的探讨低温保护液肺动脉灌注对右腋下小切口心内直视术的肺保护作用。方法对照组与试验组各20例,全部为室间隔缺损病例,无合并肺动脉高压及其他心内畸形。对照组(常规手术组):采用右腋下直切口开胸常规建立体外循环进行心内直视手术。试验组(肺灌注组):患者体位、切口选择、建立体外循环同对照组,阻断升主动脉后同时经肺动脉灌注低温保护液。分别在不同时点检测动脉血中性粒细胞计数及肿瘤坏死因子(TNF)-α、巨噬细胞趋化因子(MIP)-2含量,髓过氧化物酶(MPO)活性,计算氧合指数(OI)、呼吸指数(RI),同时获取少许肺组织进行病理形态学检测。结果两组患者年龄、体质量、体外循环时间、主动脉阻断时间差异无统计学意义,两组患者均无死亡,无低心排综合征,无呼吸功能不全等并发症。试验组和对照组比较:主动脉阻断后不同时点,OI增高(P<0.05),RI降低(P<0.05);与对照组比较主动脉阻断后不同时点,血清TNF-α、MIP-2、MPO活性水平明显降低(P<0.05);与对照组比较主动脉开放后不同时点中性粒细胞计数明显降低(P<0.05)。结论低温保护液肺动脉灌注可以减轻右腋下小切口心内直视术的全身炎性反应,改善肺功能。

Objective To investigate the protective effect of hypothermal pulmonary artery perfusion on lungs during intraeardiae operation via right subaxillary small incision. Methods Forty cases of ventrieular septal defect, excluded for pulmonary hypertension and other cardiac malfortnations, were randomized into a control group or an experi- mental group with 20 eases in each. The control group received intraeardiac operation via right vertical subaxillary mini-thoraeotomy with routine extracorporeal bypass. In the experimental group, similar patient positioning, incision and circulation bypass were used, while the patients received pulmonary artery perfusion with hypothermia perfusate after blockage of the ascending aorta. The plasma levels of TNF-et, MIP-2 and the activity of MPO in arterial blood were analyzed at different time spots. The oxygenation index, respiration index and neutrophil counts were also determined. Histological study of lung tissue samples was performed. Results The two groups were well matehed with regards to the patient age, body weight, durations of extraeorporeal bypass and ascending aorta blockage. None of the patients died or was found to have low cardiac output syndrome, respiratory insuffieiency or other complications. Compared with the control group after ascending aorta blockage, the experimental group showed higher OI （P〈0.05）, lower RI （P〈0.05）, lower plasma levels of TNF-α and MIP-2, reduced MPO activity, and decreased neutrophils counts （P〈0.05） at differ- ent time spots. Conclusion Pulmonary artery perfusion with hypothermia perfusate may ameliorate systemic inflamma- tory response triggered by intracardiac operation via right subaxillary small incision and improve pulmonary function.