氨茶碱对心肺转流下心脏手术患儿肺功能的影响

Effect of aminophylline on pulmonary function of children undergoing open cardiac surgery

目的研究氨茶碱在心肺转流(CPB)术中对肺功能的保护作用。方法择期行先天性心脏病手术的患儿40例,年龄2～6岁,体重12～20kg,随机分为氨茶碱组(A组)和对照组(C组),每组20例。A组于麻醉诱导插管后先静脉缓慢(5min内)注射浓度为1mg/ml的氨茶碱2mg/kg,其后按0.5mg.kg-1.h-1经微量泵持续静脉输注浓度为1mg/ml的氨茶碱至CPB结束。C组以生理盐水替代A组用的氨茶碱作为对照。监测给氨茶碱前(T1)、停机后5min(T2)、30min(T3)、60min(T4)的静态肺顺应性(Cst)和动态肺顺应性(Cdyn);记录HR、MAP、中心静脉压(CVP)、潮气量(VT)、气道峰压(Pmax)、平均气道压(Paw)、气道平台压(Pplat)、呼气末正压(PEEP)、吸入氧浓度(FiO2)、PaO2、PaCO2,计算呼吸指数(RI)及氧合指数(OI)。检测血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)浓度。结果T2、T3时A组HR显著加快,并快于C组(P<0.05)。T2～T4时C组OI、Cst、Cdyn较T1及同时点的A组明显下降,而Paw及RI明显升高(P<0.05)。C组T2～T4时TNF-α、IL-8浓度显著高于T1时及A组(P<0.05)。结论氨茶碱可通过抑制CPB的炎性反应对手术患儿具有良好的肺功能保护作用。

Objective To evaluate the effect of aminophylline on pulmonary function in the children with cardiac disease undergoing cardiopulmonary bypass （CPB）. Methods Forty children, aged 3 to 6 years old, weighed 12-20 kg were randomly assigned to two groups with 20 cases each. Group A was infused aminophylline 2 mg/kg slowly after induction, which was followed by 0. 5 mg· kg^-1·h^-1 until the end of CPB. Normal saline was slowly infused instead of aminophylline in group C as the control. Hemodynamic variables and respiratory index were recorded and serum TNF-α and IL- 8 were detected before administration of aminophylline （T1） and at 5 （T2）, 30 （T3） and 60 minutes （T4） after CPB. RI and OI were calculated. Results In group C,Cst,Cdyn and OI were significantly lower and Paw and R I were higher at T2 ,T3 and T4 than those at T1 and than those in group A（P〈0.05）. The serum TNF-α and IL-8 of group C were significantly higher at T2 ,T3 and T4 than those at TI（P〈0. 05）. HR of group A was increased at T2 and T3 ,which was higher than that of group C（P 〈0.05）. Conclusion Aminophylline has protective effects on pulmonary function of the children undergoing open heart surgery through inhibiting inframmatory response to CPB.