氨茶碱与乌司他丁合用在婴幼儿体外循环中的肺保护作用

The combined effects of amphylline and ulinastatin to lung protection in infants undergoing cardiac operation

目的探讨氨茶碱与乌司他丁合用对体外循环（CPB）所致肺损伤的保护作用。方法选取体重≤7kg的单纯室间隔缺损新生儿及低体重婴幼儿60例，采用随机化分组表分为氨茶碱组（A组）、乌司他丁组（U组）、联合组（AU组）和对照组（C组），每组各15例。A组麻醉诱导后静脉注射氨茶碱5mg／kg，并在体外循环过程中按每小时0．5mg／kg维持；U组在CPB过程中应用10000U／k乌司他丁；AU组联合应用上述两种药物；C组未给予氨茶碱及乌司他丁。选取CPB启动前（t1）、CPB结束后1h（t2）和CPB结束后24h（t3）计算胸肺顺应性（Cs）、动态肺顺应性（Cd）以及呼吸指数（RI）。结果术后对照组1例因多器官功能衰竭死亡，乌司他丁组1例因严重心律失常死亡。手术后1h，AU组Cs优于A组、C组，RI优于A组、U组；手术后24h，AU组Cs和RI优于其他组，Cd优于A组、U组。结论氨茶碱和乌司他丁可减轻体外循环引起的急性炎症反应和CPB导致的肺损伤；两者联合应用有协同作用。

Objecitive To discuss the combined protective effects of amphylline and ulinastatin to lung injury in infants who underwent cardiac operation under cardiopulmonary bypass （CPB）. Motbeds 60 neonates or infants who weight less than 7 kilogram and suffering with single ventricular septal defect were divided randomly into 4 groups： the combo group, the amphylline group, the ulinastatin group and the control group （15 cases for each group）. Patients in the amphylline group were treated with intravenous injection of amphylline （5 mg / kg） after the anesthesia induction, and then continued （0.5 mg / kg / h） during the total CPB. Patients in the nlinastatin group were treated with ulinastatin at the dosage of 10 000 U / kg during the CPB. Patients in the combo group were treated with both amphylline and ulinastatin at the same manner mentioned above. Patients in the control group were not treated with amphylline or ulinastatin. Patients in the control group were not treated with amphylliue or ulinastatin. The thoracic lung compliance （Cs）, dynamic lung compliance （Cd） and respiratory index （RI） were measured at the beginning of CPB （h）, 1 hour after the CPB 02） and 24 hour after the CPB （t3）. Results One patient in the control group died cause of muhi-organ failure. One patient in the ulinastatin group died cause of severe arrhythmias. At t2,the Group AU had a higher Cs value than that of Group A and C ,and a lower RI value than that of Group A and U. At t3, the Group AU had a higher Cs value and a lower RI value than those of other groups, and a higher Cd value than that of Group A and U. Conlusions Amphylline and ulinastatin can palliate the acute inflammatory reaction caused by CPB and palliate its lung injury. When combined used, there are synergistic effect.