肺动脉灌注HTK液在法乐氏四联症矫治术中的肺保护作用

Lung perfusion with HTK solution relieves lung injury in corrections of Tetralogy of Fallot

目的:评价体外循环(CPB)中肺动脉灌注低温HTK液对法乐氏四联征(TOF)患儿肺的保护作用。方法:选取TOF患儿24例,随机分为肺动脉灌注组(n=12)和对照组(n=12),计算各组氧合指数(OI)和肺泡-动脉氧分压差(AaDO2),硫代巴比妥酸反应法检测丙二醛(MDA)水平,ELISA法检测内皮素1(ET-1)、可溶性细胞间黏附分子-1(sICAM-1)和P-选择素水平。结果:体外循环(CPB)后0、12、24、48 h,灌注组的OI均显著高于对照组(P<0.05,P<0.01),两组间变化的趋势有显著差异(P<0.05,P<0.01);灌注组的AaDO2均显著低于对照组(P<0.05,P<0.01);两组间CPB后MDA、ET-1、sICAM-1和P-选择素的水平变化趋势均有显著差异(P<0.05,P<0.01)。结论:CPB中肺动脉灌注低温HTK液可有效地减轻内皮细胞损伤,提高TOF矫治术后患儿的肺换气功能,改善预后。

AIM ： To evaluate the protective effect of pulmonary perfusion with hypothermic HTK solution on lung function after cardiopulmonary bypass in corrections of tetralogy of Fallot. METHODS： Twenty- four consecutive infants with tetralogy of Fallot were randomly divided into perfusion group （n = 12） and control group （n = 12）. Oxygen index, alveolar-arterial 02 gradient, serum levels of malondialdehyde, endothelin-1, sICAM-1, and P-selectin were measured before commencement and serially for 48 h after termination of bypass. RESULTS： Oxygenation values were better preserved in perfusion group than in control group. The trend revealed significant differences in serum levels of malondialdehyde, endothelin-1, slCAM-1, and P-selectin between groups. Serum levels of malondialdehyde, sICAM-1, and P-selectin tended to increase after bypass in control group, but remained at a low level in perfusion group. Serum levels of endothelin-1 increased significantly from 12 h after bypass in both groups and the levels in control group were significantly higher than those in peffusion group. CONCLUSIONS： This study suggests that puhnonary perfusion with hypothermic HTK solution during cardiopulmonary bypass relieves lung injury in infants with tetralogy of Fallot.