盐酸戊乙奎醚对小儿体外循环后炎性反应及肺损伤的影响

Effects of penehyclidine hydrochloride on inflammatory response and lung injury in children after cardiopulmonary bypass

目的:观察盐酸戊乙奎醚对小儿先心病体外循环(CPB)后细胞因子及肺功能的影响。方法:先心患儿随机分为盐酸戊乙奎醚组(P组,n=15)和对照组(C组,n=12)。P组注射盐酸戊乙奎醚0.02mg/kg,C组注同体积NS。于诱导后、主动脉开放30min、2、6及24h采集动脉血,ELISA法测TNF-α、IL-6、IL-8、IL-10及MMP-9含量,行血气分析及动态顺应性(Cd)测定,计算A-aDO2、呼吸指数(RI)等指标。结果:P组在主动脉开放30min、24h血浆IL-6、TNF-α水平较C组明显降低(P<0.05),主动脉开放30min、6、24h血浆IL-8水平较C组明显降低(P<0.05),主动脉开放2、24hPMN含量较C组明显降低(P<0.05),两组各时点血浆IL-10及MMP-9比较差异无统计学意义。P组主动脉开放后各点Cd明显高于C组,而RI较C组明显降低(P<0.05),主动脉开放6、24hA-aDO2较C组明显降低(P<0.05)。结论:盐酸戊乙奎醚可减轻CPB后炎性反应从而保护肺功能。

Objective To investigate the effects of penehyclidine hydrochloride on inflammatory response and lung injury in children with congenital heart disease （CHD） who after cardiopulmonary bypass. Methods Children with CHD were randomly divided into penehyclidine group （group P,n = 15） or control group （group C,n=12）. Children in group P were injected with 0.02 mg/kg of penehyclidine hydrochloride, and those in group C were injected with the same volume of NS. Arterial blood plasma samples were taken and the contents of TNF-α, IL-6, IL-8, IL-10, and MMP-9 were detected by ELISA after anesthesia induction, and at 30 rain, 2, 6, 24 h after aorta patefaction. And blood gas analysis and pulmonary dynamic compliance （Cd） were determined at the same time for calculating A-aDO2 and respiritony index （R1）. Results In group P, the contents of IL-5, TNF-a were significantly lower at 30 min and 24 h,IL-8 was significantly lower at 30 rain, 6 h and 24 h, and PMN was significantly lower at 2 h and 24 b after aorta patefaction than those in group C （P 〈 0.05）. There were no significant differences in tire contents of IL-10 and MMP-9 between the two groups. Cd value at ,every. time point were significantly higher, but the values of RI were significantly lower in group P than those in group C （P 〈 0.05）. The values of A-aDO2 were significantly higher at 6 h and 24 h after aorta patefaction in group P than that in group C （P 〈 0.05）. Conclusion Penehyclidine hydrochloride could effectively reduce lung injury via inhibiting neutrophil activation and cytokines release.