术中氧合血持续肺动脉灌注对室间隔缺损合并肺动脉高压患儿的肺保护作用

Intraoperative blood oxygenation continuous pulmonary artery perfusion lung protection of ventricular septal defect combined children with pulmonary hypertension

目的研究在体外循环手术中使用氧合血进行持续肺动脉灌注对合并肺动脉高压的室间隔缺损患儿的肺保护作用。方法 30例室间隔缺损合并肺动脉高压的患儿,随机均分为试验组和对照组。均在体外循环下进行室间隔缺损修补手术。试验组在体外循环中采用氧合血持续肺动脉灌注,对照组未行肺动脉灌注。两组患儿在体外循环前,主动脉开放后6、12、24h时抽取动脉血3ml.采用酶联免疫吸附法(ELISA法)检测丙二醛(MDA)的水平。并抽取动脉血进行血气分析,计算体外循环前,主动脉开放后6、12、24h时的氧合指数(QI),并记录气道峰压和呼吸机辅助时间,进行统计分析。结果试验组术后12、24h的QI高于对照组(P<0.05),试验组术后6、12h的气道峰压明显低于对照组(P<0.05)。试验组术后呼吸机辅助时间明显低于对照组(P<0.05)。试验组术后6、12、24h时MDA水平均低于对照组(P<0.05)。结论氧合血持续肺动脉灌注能减轻室间隔缺损合并肺动脉高压患儿在体外循环中的肺损伤。

Objective To study the effects of blood oxygenation in extracorporeal circulation operation on continuous pulmonary artery perfusion of merger pulmonary hypertension of ventricular septal defect with pulmonary protection. Methods 30 cases of ventricular septal defect combined pulmonary hypertension were randomly divided into experimental group and control group, 15 cases in each group. Both ventricular septal defect repair surgery under extracorporeal circulation. Patients with blood oxygenation in extracorporeal circulation continuous pulmonary artery perfusion, the control group no pulmonary artery perfusion. Two groups of children in front of the extracorporeal circulation, aorta open after 6,12 and 24 h when extracting arterial blood 3 ml. By using enzyme-linked immunosorbent （ELISA） to detect malondialdehyde （MDA） level. And extract the arterial blood for blood gas analysis, calculation of extracorporeal circulation, aorta open after 6,12 and 24 h oxygenation index （QI）,and record the airway peak pressure and auxiliary time breathing machine, were analyzed. Results Group of 12,24 h after QI is higher than the control group （P〈0.05）,group of 6,12 h postoperative airway peak pressure significantly lower than the control group （P〈0.05）. Patients postoperative respiratory machine auxiliary time significantly lower than the control group （P〈0.05）. Patients postoperative 6, 12 and 24 h when the level of MDA was lower than the control group （P〈0.05）. Conclusion Blood oxygenation continuous pulmonary artery perfusion can reduce ventricular septal defect combined pulmonary hypertension in children with lung injury in extracorporeal circulation.