体外循环中低温Perfadex液对室间隔缺损肺动脉高压患者的肺保护作用

Hypothermic perfadex solution reduces the lung injury of the infant with pulmonary hypertension after cardiopulmonary bypass

目的探讨体外循环中肺动脉灌注低温Perfadex液对合并肺动脉高压婴幼儿的肺功能保护作用：方法将30例合并肺动脉高压的室间隔缺损患儿分为对照组（15例）和肺保护组（15例），均在体外循环下行心内直视手术。肺保护组体外循环期间于心脏阻断后向肺动脉灌注低温Perfadex液，对照组不灌注。分别于转流前、转流结束、手术结束、术后6h及术后24h测定两组白介素6（IL-6）、白介素8（IL-8）、白介素10（IL-10）以及血浆脂质过氧化物丙二醛（MDA）水平；计算氧合指数（PaO2/FiO2）和肺静态顺应性（TV/Pause）。结果两组体外循环后IL-6、IL-8、IL-10及MDA水平均升高，手术结束时达峰值，以后逐渐下降，术后24h仍高于术前；肺保护组各时点IL-6、IL-8及MDA上升幅度低于对照组（P〈0．01），各时点IL-10上升幅度高于对照组（P〈0．01）；肺保护组手术结束、术后6h及24h血氧指数高于对照组，P〈0.05或0.01，两组肺静态顺应性较术前明显降低，实验组变化程度明显低于对照组（P〈0．05）。结论肺动脉灌注低温Perfadex液能明显保护肺动脉高压患者术后呼吸功能。

Objective To study the protective effects of pulmonary artery perfusion with hypothermic perfadex solution on the lung functions of the children with pulmonary hypertension （PH） after cardio pulmonary bypass （CPB）. Methods 30 children with congenital heart disease and PH were random divided in to the control group （n = 15） and the protective group （n = 15）. The routine techniques were performed in all patients, and puhnonary artery infusion of 4℃ perfadex solution was performed additionally in patients from the protective group during the process of total CPB. The plasma intedeukin-6 （IL-6）, IL-8. IL-10 and malondialdehyde （MDA） and the patients＇ oxygen index （OI） were measured and lung static compliance （Cstat） were calculated at different time points （before surgery, at the end of CPB, Oh, 611, 24h postoperatively）. Results In both groups, compared with the baseline values,the plasma levels of IL-6, IL-8, IL-10, MDA were increased postoperatively which peaked at the end of surgery and maintained to a high level 24 h postoperatively. Compared with the control group, the IL-6, IL-8, MDA were significantly lower （P〈0.01） and the IL-10 was higher （P〈 0.01） in the protective group. The patients＇ OI and Cstat were higher in the lung protective group than those in the control group （P〈 0.05）. Conclusions Perfusion with hypothermic perfadex solution could ameliorate lung function after cardiopulmonary bypass.