外源性肺表面活性物质对小儿体外循环肺保护的疗效观察

Protective effect of exogenous pulmonary surfactant on pulmonary function during cardiopulmonary bypass in children

目的观察外源性肺表面活性物质对小儿体外循环肺保护的临床疗效。方法将２４例先天性心脏病室间隔缺损伴肺动脉高压患儿，随机分为对照组和用药组。测定两组患儿围术期肺的动态顺应性、氧合指数、气管插管维持时间、肺循环血浆丙二醛含量及肺组织超微结构观测。结果体外循环后各时点用药组肺动态顺应性显著高于对照组（Ｐ＜００５），氧合指数显著低于对照组（Ｐ＜００１）。对照组气管插管维持时间为１３８小时，而用药组为８９小时（Ｐ＜０００１）。肺循环血浆丙二醛含量显著高于用药组（Ｐ＜００１）。肺组织超微结构观察证实用药组肺损伤的程度也较对照组明显减轻。结论预防性应用外源性天然肺表面活性物质对小儿室间隔缺损伴肺动脉高压患者体外循环术后肺功能不全有明显的保护作用。

Objective To study the protective effect of exogenous pulmonary surfactant (PS) on respiratory insufficiency after cardiopulmonary bypass in children. Methods 24 children of VSD associated with pulmonary hypertension undergoing heart surgery with cardiopulmonary bypass(CPB) were randomly divided into two groups: control group and PS group. In the PS group ,exogenous natural porcine PS 150mg/kg was dropped into the intracheal tube before opening the chest and removing the aortic clamp. Equal amount of normal saline was given in the control group. Lung dynamic compliance and oxygenate index were measured before and after operation. The plasma molondialdehyde(MDA) concentration of the lung was analysed perioperatively with ELISA methods . The intubation time of the two groups and ultrastructure of the lung also was measured. Results The dynamic compliance of the PS group was higher than that of the control group ( P <0 05),and the oxygenate index was significantly lower than that of the control group ( P <0 01 ) after CPB. Compared to the control group , the exogenous PS was able to markedly reduce the generation of MDA( P <0 01) The intubation time of the PS group was 8 9 hours, much shorter than 13 8 hours of the control group( P <0.001). The histological examination confirmed that the degree of pulmonary damage was significantly ameliorated in the PS group. Conclusion Exogenous natural PS has protective effect on respiratory insufficiency after CPB in children with VSD asociated with pulmonary hypertention.