七氟醚预处理对先天性心脏病患儿术后肺保护的影响

Influence of sevoflurane as pretreatment on pulmonary protection in pediatric patient with congenital heart disease after surgery

目的：观察七氟醚预处理对先天性心脏病患儿心脏术后肺保护的影响。方法择期先天性房间隔、室间隔缺损患儿60例,按随机数字表法分为七氟醚组（S组）和对照组（C组）,每组各30例。两组用相同药物剂量诱导后,S组先给予5%∽6%七氟醚吸入维持4 MAC（最小肺泡浓度）30 min,C组静脉注射丙泊酚维持效应室浓度2∽4μg/ml 30 min,气管插管全身麻醉,在体外循环前（T1）,体外循环结束（T2）,术后1 d（T3）,术后3 d（T4）分别抽取患儿静脉血2 ml,检测血清丙二醛（MDA）和白介素-6（IL-6）的含量。结果与C组比较,S组T2、T3的MDA、IL-6含量减少（P〈0.05）,两组T4的MDA、IL-6含量比较,差异无统计学意义（P〉0.05）。 C组：与T1比较,T2、T3的MDA、IL-6含量升高（P〈0.05）,S组T2、T3时也升高,但差异无统计学意义（P〉0.05）。结论七氟醚预处理通过减少先天性心脏病患儿血液MDA的产生,稳定IL-6的含量,减少肺的氧化损伤和炎症反应,从而起到肺保护的作用。

Objective To observe the influence of sevoflurane as pretreatment on pulmonary protection after cardiac surgery in pediatric patients with congenital heart disease （CHD）. Methods 60 pediatric patients with congenital atrial/ventricular septal defects were selected and evenly divided into the sevoflurane group （the group S） and the control group （the group C） according to the random number table.After induction of the same dosage from the same anesthetic, inhalation of 5%-6% sevoflurane was firstly provided to maintain minimum alveolar concentration （MAC） for 30 mini-utes in the group S, while in the group C,the effect compartment concentration was maintained in 2∽4 μg/ml for 30 miniutes by venous infusion of propofol.After that,intubation anesthesia was performed.2 ml venous blood before extra-corporeal circulation （T1）,after extracorporeal circulation （T2）,after one day surgery （T3）,after three days surgery （T4） were drawn respectively in order to determine the content of serum malondialdehyde （MDA） and interleukin-6 （IL-6）. Re-sults In comparison with the group C,the content of MDA and IL-6 at T2,T3 reduced in the group S （P〈0.05） and there was a statistical difference of MDA and IL-6 at T4 of the two groups （P〉0.05）.The group C：MDA and IL-6 content at T2,T3 increased compared with T1 （P〈0.05） while in the group S,the content of MDA and IL-6 increased,but there was no statistical difference （P〉0.05）. Conclusion Sevoflurane as pretreatment plays a role of pulmonary protection by de-creasing the production of MDA in blood in patients with CHD,stabilizing the content of IL-6,and reducing pulmonary oxidative damage and inflammation response in order to protect lung.