盐酸氨溴索对小儿体外循环肺损伤的保护作用

The Protective Effect of Ambroxol on Lung Injury during Cardiopulmonary Bypass in Children

目的:探讨盐酸氨溴索在小儿体外循环(CPB)手术中对肺的保护作用。方法:选择40例行房、室间隔缺损修补术的4～9岁的患儿,随机分为盐酸氨溴索组(M组)20例和对照组(C组)组20例。M组于麻醉后切皮前匀速静脉滴注盐酸氨溴索4.5mg/kg溶于50mL平衡液中,C组用等容量平衡盐溶液静脉注射,分别于麻醉后(T1)、给药后10min(T2)、停体外循环后5min(T3)、入ICU后1h(T4)、入ICU后2h(T5)、拔管前(T6),根据麻醉机及呼吸机记录气道峰压(PIP)和平台压(Plat)、气道阻力(R)及肺顺应性(CL)。采集静脉血液测定术前、术中、术后血白细胞(WBC)。结果:2组R处理因素与时间效应差异均有统计学意义(均P<0.01),2组在T5、T6时差异有统计学意义(P<0.01),2组均在T4时点达到最高值,以后呈下降趋势。2组患者CL在T1和T5时点差异均无统计学意义(P>0.05)。2组患者WBC组间和时间效应差异均有统计学意义(均P<0.01),处理因素与时间效应间存在交互作用(P<0.01)。2组PIP和Plat处理效应与时间效应差异均有统计学意义(均P<0.001);处理效应与时间效应存在交互作用(均P<0.01)。结论:在体外循环前使用盐酸氨溴索对肺有一定的保护作用。

Objective：To investigate the protective effect of ambroxol on lung injury during cardiopulmonary bypass（CPB） in children.Methods：Forty patients aged 4-9,scheduled operation of atrial septal defect （asd）／ventricular septal defect （vsd）,were randomly allocated into two groups,ambroxol group （group M,n=20） and control group （group C,n=20）.Ambroxol （4.5 mg/kg in 50 mL of saline） was injected before CPB in group M.The equal volume of normal saline was infused in group C.Blood samples were taken to detect white blood cells （WBC） before operation,after anesthesia （T1）,10 min after administration （T2）,5 min after CPB （T3）,1 h after ICU admission （T4）,2 h after ICU admission （T5）,and before decannulation （T6）.Results：There were significant differences in R factors and time effect between two groups （P 0.001）,and there were significant differences in T5 and T6 between two groups （P 0.01）,and which reached the highest level in T4 in two groups and then showed a downward trend.There was no significant difference in lung compliance （CL） in T1 and T5 between two groups （P 0.05）.There was a significant difference in value of WBC between two groups （P 0.001）.There was a significant interaction between processing factors and time effects （P 0.01）.There were significant differences in the peak inspiratory pressure （pip） and plateau pressure （Plat） between two groups （P 0.01）,which showed a significant interaction between processing and time effects （P 0.01）.Conclusion：Ambroxol has the protective effect on lung injury induced by CPB.