肺动脉灌注低温肺保护液对法乐四联症根治术中肺的保护作用

Lung protection by perfusion with hypothermic protective solution to pulmonary artery during total correction of tetralogy of Fallot

目的 探讨法乐四联症 (tetralogyofFallot,TOF)根治术中 ,肺动脉灌注低温肺保护液对肺损伤的保护作用。 方法 64例行TOF根治术的患儿随机分为肺保护组 34例 ,对照组 30例。肺保护组患儿体外循环期间肺动脉灌注低温肺保护液 ,对照组患儿常规行TOF根治术。术前和术后 0、6、1 2、2 4、48h监测患儿血流动力学、呼吸功能、血浆脂质过氧化物丙二醛 (MDA)、肿瘤坏死因子α(TNF α)的变化。收集患儿术后 6h气管吸出物 ,检测其炎性介质IL 6、IL 8水平。术后取患儿右下肺组织 ,观察组织形态学改变。 结果 肺保护组患儿术后 6、1 2、2 4h血氧指数高于对照组 (分别t =2 40 0 ,P <0 0 5 ;t=3 898,P <0 0 1 ;t=3 339,P <0 0 1 ) ;呼吸机辅助通气时间和ICU监护时间短于对照组 (分别t=- 2 652 ,P <0 0 5 ;t =- 2 0 81 ,P <0 0 5) ;术后 0、6h血浆MDA水平低于对照组(分别t=- 4 2 55 ,P <0 0 1 ;t=- 2 372 ,P <0 0 5) ;术后 0、6、2 4h血浆TNF α水平低于对照组 (分别t=3 1 1 2 ,P <0 0 1 ;t=3 0 72 ,P <0 0 1 ;t=2 30 6 ,P <0 0 5) ;气管吸出物中IL 6 ,IL 8水平低于对照组 (分别t=- 2 41 9P <0 0 5 ;t=- 2 61 3P <0 0 1 )。肺组织活检病理检查结果 ,对照组肺组织可见炎症细胞浸润。

Objective To study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot(TOF) Methods Sixty four consecutive children with TOF were randomly divided into control group ( n =30) and lung protective group ( n =34) The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery Patients in the control group were subjected to routine approach Patients′ hemodynamics and lung functions were monitored Plasma malondialdehyde (MDA) , TNF α and IL 6,IL 8 in tracheal suction were measured Lung biopsy specimens were obtained after operations to study histological changes Results The oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation( t =2 400, P <0 05; t =3 898, P <0 01; t =3 339, P <0 01,respectively) The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group( t =-2 652, P <0 05; t = -2 081 , P <0 05) The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations( t =-4 255, P <0 01; t =-2 372, P <0 05 respectively) The level of TNF α was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation( t =3 112, P <0 01; t =3 072, P <0 01; t =2 306, P <0 05, respectively). The levels of IL 6, IL 8 in tracheal suction were lower in the lung protective group( t =-2 419, P <0 05; t =-2 613, P <0 01). Tissue examination showed intraalveolar edema ,capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group Conclusion Perfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF