不同时机左心引流对婴儿体外循环肺保护作用的研究

Left heart venting for lung protection at different time during extracorporeal circulation in infants

目的探讨不同时机左心引流对婴儿体外循环肺保护的作用。方法 81例≤10个月的先天性心脏病患儿,分成三组,N1组体外循环开始即刻开启左心引流,术毕,心排量恢复后停止;N2组主动脉阻断,心脏停跳后开启左心引流,结束与N1组相同;N3组左心引流开始时间与N1组相同,心内操作结束后停止。比较三组体外循环前及结束时、术后1h、6h血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)的浓度、气道峰压(Ppeak)、气道平压台(Pplate)、肺水含量(TAF)、氧合指数(OI)及术后呼吸机辅助通气时间。结果 N1组体外循环后TNF-α、IL-6的浓度及Ppeak、Pplate及TAF较其他组明显下降(P<0.05),OI则明显增高(P<0.05),呼吸机辅助通气时间较其他组明显缩短(P<0.05)。结论早开始、晚结束左心引流能减轻婴幼儿体外循环肺损伤,具有良好的肺保护作用。

OBJECTIVE To investigate the left heart venting for lung protection at vary timing during extracorporeal circulation（ECC） in infants.METHODS 81 cases of less than 10-months-old with congenital heart disease（CHD） undergoing ECC were randomly divided into three experimental groups（N1,N2 and N3）.In the N1 groups,left heart venting was started at the beginning of ECC,and ended after cardiac output recovering.In the N2 groups,left heart venting was started after ascending aorta clamping,and ended at the same time of N1 group.In the N3 groups,left heart venting was started at the same time of N1 group,and ended when the operating in heart was finished.The plasma levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,peak airway pressure（Ppeak）,platform airway pressure（Pplate）,oxygenation index（OI） and thoracic fluid content（TAF） were compared in three groups after 1 h,2 h of operation and Peri-ECC.The time of mechanical ventilation were compared in three groups.RESULTS The plasma levels of TNF-α,IL-6,Ppeak,Pplate and TAF in the N1 group decreased more significantly and OI in the N1 group increased more significantly after ECC than in the other groups（P0.05）.The duration of mechanical ventilation following operation in the N1 group was shorten than in the other groups（P0.05）.CONCLUSION The technique of early starting and later completing left heart venting can reduce the lung injury during ECC,and has better effect of lung protection for infants after ECC.