不同时间点静脉泵注前列地尔对行肝移植手术治疗的终末期肝病患儿血浆Clara细胞分泌蛋白及动脉血气分析指标的影响

Effect of intravenous pumping of alprostadil at different time points on plasma Clara cell secretory protein and arterial blood gas analysis indices in end-stage liver disease children undergoing liver transplantation

目的观察不同时间点静脉泵注前列地尔对行肝移植手术治疗的终末期肝病患儿血浆Clara细胞分泌蛋白(CCSP)及动脉血气分析指标的影响。方法将择期行肝移植手术治疗的44例终末期肝病患儿随机分为C组20例与K组24例。C组患儿在新肝期开始静脉泵注0.5 ng/(kg·min)前列地尔至术毕,K组患儿手术开始后立即静脉泵注0.5 ng/(kg·min)前列地尔至术毕。比较两组患儿切皮前(T_(0))、无肝期30 min时(T_(1))、新肝期30 min时(T_(2))、手术结束时(T_(3))、术后12 h(T_(4))、术后24 h(T_(5))、术后48 h(T_(6))的血浆CCSP含量及动脉血气分析指标,以及术后儿科ICU住院时间、机械通气时间及肺部感染发生率。结果在T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,K组血浆CCSP含量均低于C组(均P<0.05)。不同时间点两组患儿PaO_(2)、PaCO_(2)、肺泡气-动脉血氧分压差、氧合指数的差异均无统计学意义(均P>0.05),但两组上述指标均有随时间变化的趋势(均P<0.05)。K组患儿术后机械通气时间、儿科ICU停留时间均短于C组(均P<0.05),但两组患儿术后肺部感染发生率差异无统计学意义(P>0.05)。结论肝移植手术开始后立即静脉泵注前列地尔可降低终末期肝病患儿血浆CCSP含量,缩短患儿术后机械通气时间和儿科ICU停留时间,安全性良好。

Objective To observe the effect of intravenous pumping of alprostadil at different time points on plasma Clara cell secretory protein(CCSP)and arterial blood gas analysis indices in end-stage liver disease children undergoing liver transplantation.Methods A total of 44 children with end-stage liver disease undergoing selective liver transplantation were randomly assigned to group C(20 cases)or group K(24 cases).Children in group C received intravenous pumping of 0.5 ng/(kg􀅰min)alprostadil at the beginning of neohepatic stage until the end of operation,while children in group K received immediately intravenous pumping of 0.5 ng/(kg􀅰min)alprostadil after the beginning of operation until the end of operation.The plasma CCSP content and arterial blood gas analysis indices of children before skin incision(T_(0)),at 30 minutes of anhepatic stage(T_(1)),at 30 minutes of neohepatic stage(T_(2)),at the end of operation(T_(3)),12 hours after operation(T_(4)),24 hours after operation(T_(5)),and 48 hours after operation(T_(6)),and the length of pediatric ICU stay,mechanical ventilation duration,as well as incidence rate of pulmonary infection of children after operation were compared between the two groups.Results Group K yielded lower contents of CCSP at T_(2),T_(3),T_(4),T_(5),and T_(6)as compared with group C(all P<0.05).No statistically significant difference in PaO_(2),PaCO_(2),alveolar-arterial oxygen difference,oxygenation index was found between the two groups(all P>0.05);however,the aforementioned indices of both groups interpreted a trend over time(all P<0.05).Group K exhibited shorter mechanical ventilation duration and length of pediatric ICU stay after operation as compared with group C(all P<0.05);however,there was no statistically significant difference in the incidence rate of postoperative pulmonary infection between the two groups(P>0.05).Conclusion Immediate intravenous pumping of alprostadil after the beginning of liver transplantation can reduce end-stage liver disease children′s plasma CCSP content,and shorten postoperative mechanical ventilation duration and length of pediatric ICU stay in children,exerting a favorable safety.