肺动脉灌注低温保护液对肺血管内皮损伤的保护作用

Effects of pulmonary artery perfusion with hypothermic protective solution on pulmonary vascular endothelial cell injury during cardiopulmonary bypass

目的 研究肺动脉灌注低温保护液 ,对体外循环中肺血管内皮损伤的保护作用。方法 6 4例行法洛四联症 (TOF)根治术病儿随机分为肺保护组 34例 ,对照组 30例。肺保护组体外循环期间肺动脉灌注低温保护液 ,对照组常规行TOF根治术。围手术期检测血浆内皮素 (ET)和冯维尔布兰德因子 (vonwillebrandfactor,vWF)水平。术后取右下肺组织活检标本 ,观察肺血管内皮组织形态学改变 ,冰冻切片免疫组化法检测肺血管内皮细胞粘附因子 (ICAM) 1的表达。术后监测血流动力学和呼吸功能 (呼吸指数 )等临床指标。结果 进ICU的 0h肺保护组ET和vWF水平明显低于对照组 (P <0 0 5 ) ,肺保护组肺血管内皮细胞ICAM 1表达明显弱于对照组 (P <0 0 5 )。肺组织活检对照组可见肺间质炎性细胞浸润 ,内皮细胞不完整 ,细胞结构退化 ,气血屏障加宽。肺保护组无明显病理改变。肺保护组呼吸机辅助通气时间和ICU监护时间均短于对照组 (P <0 0 5 )。术后 12h和 2 4h呼吸指数肺保护组低于对照组 (P <0 0 5 )。结论 肺动脉灌注低温保护液对体外循环中肺血管内皮损伤有保护作用 ,改善术后肺功能。

Objective: To evaluate the effects of hypothermic protective solution perfusion to pulmonary artery on lung vascular endothelial cell injury during cardiopulmonary bypass. Methods: 64 children with tetrogy of Fallot were randomly divided into lung protect group (n=34) and control group (n=30). The way of lung protection was to perfuse with hypothermic protective solution to pulmonary artery. Routine approach was used in control group. Plasma ET and vWF were measured. Lung biopsy specimens were obtained at end of operation in order to study histological changes of lung vascular endothelium. The expression of ICAM 1 on lung vascular endothelium was detected. Patients' hemodynamics and lung functions were monitored. Results: ET and vWF were lower in lung protect group when compared with control group at 0 hour after operation (P<0 05). The expression of ICAM 1 on lung vascular endothelium in lung protect group was lower than that in control group (P<0 05). Tissue examination showed leukocytes accumulation, of lung vascular endothelial cell degeneration and broadened gas blood barrier in control group, whereas no change occurred in lung protect group. The time of mechanical ventilation and staying in ICU were significantly shorter in lung protect group than that in control group (P<0.05). The respiratory index in lung protect group was lower than that in control group at 12 hour and 24 hour postoperatively (P<0 05). Conclusion: Perfusion with hypothermic protective solution to pulmonary artery during CPB could protect lung vascular endothelial cell during cardiopulmonary bypass and improve pulmonary function.