低温保护液对重度肺动脉高压患者体外循环时的肺功能保护作用

Pulmonary artery perfusion with hypothermic solution reduces the lung injury of the children with pulmonary hypertension after cardiopulmonary bypass

目的 评价保护液低温肺灌注对合并重度肺动脉高压患儿体外循环后肺功能的保护作用。方法 34例重度肺动脉高压先天性心脏病患儿分为对照组 (2 3例 )和肺保护组 (11例 ) ,对照组行常规手术矫治心内畸形 ,保护组于心脏阻断后向肺动脉灌注低温肺保护液 ,此后亦行常规手术完成心内畸形的矫治。术中、术后监测血流动力学、呼吸功能及生化指标 ,并留肺标本行组织学观察。结果 肺血管阻力保护组术后 6、12、2 4、36、48h分别为 (6 49± 10 4)、(6 83± 113)、(5 83± 96 )、(492± 40 )和(5 17± 70 )dyne·s·cm-5,对照组术后为 (110 5± 118)、(10 0 6± 132 )、(874± 10 0 )、(844± 10 1)和 (830± 85 )dyne·s·cm-5,保护组下降非常显著 (P <0 .0 1) ;气道阻力术后 6、12和 2 4h对照组分别为 (2 0 .0±0 .6 7)、(19.8± 0 .6 1)和 (2 1.0± 0 .96 )cmH2 O (1cmH2 O =0 .0 98kPa) ,保护组为 (15 .7± 0 .45 )、(15 .3±0 .6 7)和 (15 .0± 1.0 5 )cmH2 O ,保护组明显低于对照组 (P <0 .0 1) ;氧指数术后 72h内保护组均较对照组高 ,术后 36h保护组为 373± 38,对照组为 2 2 6± 2 1(P <0 .0 5 ) ;保护组和对照组机械通气辅助时间分别为 (2 6± 7)h和 (6 8± 19)h(P <0 .0 1) ;对照组静 /动脉中性白细胞?

Objective To evaluate portective effects of pulmonary artery perfusion with hypothermic solution on the lung tissue and functions of the children with pulmonary hypertension after cardiopulmonary bypass (CPB). Methods 34 young children with congenital heart disease and pulmonary hypertension were divided into the control group ( n =23) and the protective group ( n =11). The basic parameters (age, weight, data of catheterization and other assistant examination )were not different between two groups. The routine techniques were performed in the patients of control group and the pulmonary artery were infused with 4℃ protective solution during CPB in the protective group patients. Patients' hemodynamics and lung functions were mornitored, white blood cell counts and plasma MDA were measured, and lung biopsies were also made. Results Pulmonary vascular resistance decreased significantly in the protective group than in the control group at 6, 12,24, 36 and 48 hours after cardiopulmonary bypass (731±146, 649±104, 683±113, 583±96, 492±40, 517±70,and 510±93) dynes s cm 5 versus (814±86, 1?105±118, 1?006±132, 873±100, 844±101,830±85, and 826±127) dynes s cm 5 respectivelly (all P <0.05). Airway resistance(AR) increased in the control group after CPB, but didn′t change in the protective group. AR was lower in the protective group than in the control group at 6, 12,and 24 hrs after CPB(all P <0.01). Oxygen index was higher in the protective group than in the control group and the difference was significant at 36 hours after CPB( P <0.05). The time of mechanical ventilation was shorter in the protective group when compared with the control group ( P <0.01); Neutrophil ratio of vein and artery was 1.12 after CPB indicating neutrophil accumulation in the control group ( P <0.01); MDA was lower in the protective group than in the control group at 24, 36, 48, and 72 hours after CPB (all P <0.01 or 0.05). Tissue examination showed that intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no such changes occurred in the protective group. Conclusion Pulmonary artery perfusion with hypothermic solution could ameliorate lung function after cardiopulmonary bypass.