七氟烷预处理对婴儿体外循环肺损伤的影响

Effect on lung injury by sevoflurane pretreatment in infants of opening heart operation by Cardiopulmonary Bypass

目的探讨七氟烷预处理对婴儿体外循环心脏直视手术中肺损伤的影响。方法选择1岁以内行室间隔缺损修补术的患儿80例,按照随机配对原则分为预处理组(S组)和对照组(C组)各40例。S组在全麻诱导气管插管后开始持续吸入1.0MAC七氟烷,直至体外循环开始;C组不吸入七氟烷。记录两组在麻醉诱导后(T_0)、主动脉开放30分钟(T_1)及体外循环结束后2小时(T_2)、6小时(T_3)四个时点肺通透性指数、血浆肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、丙二醛(MDA)及超氧化物歧化酶(SOD)的含量。结果S组肺通透性指数在T_1、T_2两个时点明显低于C组,差异有显著性(P<0.05);S组血浆TNF-α、IL-6、MDA的浓度在T_1、T_2、T_3三个时点明显低于C组,差异有显著性(P<0.05);S组血浆SOD的浓度在T_1、T_2、T_3三个时点明显高于C组,差异有显著性(P<0.05)。结论七氟烷预处理用于婴儿体外循环心脏直视手术中,可以减轻全身炎性反应、减少氧自由基的产生,减轻肺组织的损伤。

Objective To study lung protection by sevoflurane pretreatment in infants under opening heart operation by Cardiopulmonary Bypass. Method 80 infants of less than 1-year-old underwent repair of ventricular septal defect were randomly assigned to two groups（ n=40 for each）：sevoflurane pretreatment group（ group S） and control group （ group C） . After the induction of general anesthesia and tracheal intubation,Group S began to continuous inhalation of 1. 0MAC sevoflurane until the beginning of cardiopulmonary bypass. The lung permeability index and the contents of TNF-α,IL-6,MOD and SOD in the blood plasma were recorded by the four time points T0（after the induction of general anesthesia）,T1（30min after aorta declamping）,2h and 6h post-CPB（T2、T3）. Result The lung permeability index of group S were markedly lower compared with group C at the time points T1 and T2（P〈0. 05）. The contents of TNF-α,IL-6 and MDA of the group S in the blood plasma were significantly lower than those of the group C at T1、T2、T3（P〈0. 05）. The contents of SOD of the group S in the blood plasma were significantly higher than those of the group C at T1、T2、T3（P〈0. 05）. Conclusion Sevoflurane pretreatment can relieve the systemic inflammatory re-sponse and reduce the production of oxygen free radical, therefore decrease the lung injury in infants.