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肺动脉灌注低温Perfadex液在法乐四联症根治术中对肺功能的保护作用

Hypothermic Perfadex solution reduces lung injury of the infant with TOF after cardiopulmonary bypass
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摘要 目的探讨体外循环中肺动脉灌注低温Perfadex液对婴幼儿法乐四联症的肺功能保护作用。方法将24例法乐四联症患儿分为对照组(12例)和肺动脉灌注组(12例),均在体外循环下行法乐四联症根治手术。肺动脉灌注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/Ppause)。结果两组体外循环后IL-6,IL-8,IL-10及MDA水平均升高[转流结束灌注组IL-6(367.1±32.6)pg/ml,IL-8(376.6±40.4)pg/ml,IL-10(265.4±42.1)pg/ml,对照组IL-6(392.7±41.5)pg/ml,IL-8(477.2±39.7)pg/ml,IL-10(197.8±42.6)pg/m1],手术结束时达峰值[灌注组IL-6(369.6±37.8)pg/ml,IL-8(536.7±31.7)pg/mI,IL-10(511.5±44.0)pg/ml;对照组IL-6(480.3±46.3)pg/ml,IL-8(585.5±47.8)pg/ml,IL-10(390.8±34.3)pg/m1],以后逐渐下降,术后24h仍高于术前;肺动脉灌注组在转流结束,手术结束及术后6h的IL.6,IL-8及MDA上升幅度低于对照组[术后6h灌注组ID6(266.5±31.1)pg/ml,IL-8(373±32.4)pg/ml,MDA(12.2±4.6)nmol/ml;对照组IL-6(311.8±42.2)pg/ml,IL_8(477.6±47.7)pg/ml,MDA(19.2±5.5)nmol/ml,P〈0.01],各时点IL-10上升幅度高于对照组(P〈0.01);肺动脉灌注组手术结束、术后6h及24h氧合指数[(367.2±32.0)mmHg,(359.1±39.8)mmHg,(401.1±54.8)mmHg]高于对照组[(316.6±48.5)mmHg,(289.5±42.8)mmHg,(346.6±68.O)mmHg,Pd0.05或0.01];两组肺静态顺应性[手术结束灌注组(3.53±0.57)ml/cmH2O,对照组(3.02±0.63)ml/cmH2O]较术前灌注组[(5.21±0.61)ml/cmH2O,对照组(4.96±0.82)ml/cmH2O]明显降低,肺动脉灌注组变化程度[手术结束(3.53±0.57)ml/cmH2O,术后6h(3.11±0.8)ml/cmH2O,术后24h(3.95±0.61)ml/cmH2O]明显低于对照组[手术结束(3.02±0.63)ml/cmH2O,术后6h(2.71±0.56)ml/cmH2O,术后24h(3.26±0.54)ml/cmH2O,P〈0.05]。结论肺动脉灌注低温Perfadex液能明显减轻婴幼儿法乐四联症术后肺损伤。 Objective To study the protective effects of pulmonary artery perfusion with hypot- hermic Perfadex solution on the lung functions of infants with Tetralogy of Fallot (TOF) after cardiopulmonary bypass (CPB). Methods A prospective study of 24 children with TOF was carried out. They were randomly divided into perfusion group (n= 12) and control group (n= 12). Routine opera- tive techniques were performed in all patients, and pulmonary artery infusion of Perfadex solution was performed additionally in the perfusion group patients after CPB. Plasma interleukin-6 (IL- 6), IL-8, ID10, Malondialdehyde (MDA) and the oxygen index (OI) were measured. Lung static compliance (Cstat) was calculated at different time points (before surgery, at the end of CPB, and 0 h,6h, 24h postoperatively). Results When compared with the baseline values,, the plasma levels of IL-6, IL-8, IL-10, MDA increased postoperatively in both groups [perfusion group IL-6(367. 1 ± 32. 6)pg/ml, IL-8 (376. 6 ± 40. 4) pg/ml, IL-10 (265.4 ± 42. 1 ) pg/ml, control group IL-6 (392. 7 ± 41.5 ) pg/ml, IL-8 (477. 2 ± 39. 7) pg/ml, IL-10 (197. 8 ± 42. 6 ) pg/ml at the end of CPB] The peak levels were seen at the end of surgery [perfusion group IL-6 (369. 6 ± 37. 8) pg/ml IL-8 (536. 7 ± 31.7) pg/ml, IL-10 (511.5 ±44. 0) pg/ml control group IL-6 (480. 3 ± 46. 3) pg/ml, IL-8 (585.5 ± 47. 8) pg/ml, IL-10 (390. 8 ± 34. 3)pg/ml] and maintained at a high level upto 24 h postoperatively. Compared with the control group, the IL- 6, IL-8, MDA levels were significantly lower in the perfusion group [IL-6 (266. 5 ± 31.1 )pg/ml, IL-8 (373 ± 32. 4) pg/ml, MI)A (12. 2 ± 4. 6 )nmol/ml vs. control group IL-6 (311.8 ± 42. 2) pg/ml,IL-8 (477. 6 ± 47. 7)pg/ml,MDA (19. 2 ± 5.5) nmol/ml,6 h postoperatively,P〈0. 01 or P〈0. 05] and the IL-10 was higher (P〈0. 01 or P〈0. 05) in the protective group. The OI and Cstat were also higher in the lung perfusion group than in the control group[perfusion group OI (359. 1 ±39. 8) rnmHg,Cstat (3. 11 ± 0. 88) ml/cmH2O; control group OI (289. 5 ± 42. 8) mmHg, Cstat (2. 71 ± 0. 56 )ml/emH2O, 6 h postoperatively, P〈0. 05]. Conclusions Perfusion with hypot- hermic Perfadex solution could protect lung function during cardiopulmonary bypass.
出处 《中华小儿外科杂志》 CSCD 北大核心 2011年第11期829-833,共5页 Chinese Journal of Pediatric Surgery
关键词 法乐四联症 婴儿 体外循环 Perfadex液 肺损伤 Tetralogy of fallot Infant Extracorporeal circulation Perfadex solution, Lung
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参考文献10

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