| 摘要: |
| 目的研究血液冬眠（BH）合剂对婴幼儿体外循环（CPB）中肺损伤的保护作用及可能机制。方法选择择期行婴幼儿心内直视手术60例，按随机数字表法分为乌司他丁（U组）、前列地尔组（P组）、一氧化氮组（N组）、血液冬眠组（UPN组）和对照组（C组），每组12例。U组在CPB预充液中加入10000U/kg乌司他丁；P组在CPB过程中以10ng/（kg·min）的速度经中心静脉持续泵入前列地尔；N组通过肺和氧合器吸入0.02‰一氧化氮；UPN组联合使用3种药物；C组不给予以上任何干预措施。分别于麻醉诱导后切皮前（T1），CPB开始后30min（T2），CPB结束时（T3），CPB结束后3h（T4），CPB结束后24h（T5）等5个时间点于桡动脉抽取动脉血，测定血浆中可溶性细胞间黏附分子-1（sICAM-1）、vWF水平和动脉血气分析，对比观察CPB中和CPB后呼吸指数（RI）。结果UPN组在T2~5各时点的血浆sICAM-1和vWF的浓度较其他各组显著下降，差异有统计学意义（P＜0.01）。与T1比较，C组、P组、N组和U组患儿在T2~5时的血浆sICAM-1和vWF水平明显升高，差异有统计学意义（P＜0.01）。UPN组患儿在T2~5时点RI较其他4组均显著下降，差异均有统计学意义（均P＜0.01）。结论在婴幼儿CPB过程中，BH通过抑制sICAM-1和vWF的过度表达,减轻CPB后肺损伤和通气功能障碍，保护并改善术后肺功能。 |
| 关键词: 血液冬眠 婴幼儿 体外循环 肺损伤 |
| DOI： |
| 分类号: |
| 基金项目:浙江省科技厅项目 |
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| Protective effect of blood hibernation on lung injury in infants undergoing cardiopulmonary bypass |
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HU Mingpin, LI Xingwang, WU Guowei, CHEN Xiaoling, LI Baoqing, LU Wenqing, JI Lixia
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the Second Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To investigate the effect of blood hibernation in protection of lung injury in infants undergoing cardiopulmonary bypass (CPB). Methods Sixty Infants with congenital heart disease undergoing cardiac surgery were equally divided into five groups and received the following drugs respectively:(1) 10000 U/kg of ulinastatin ;(2) intravenous infusion of 10 ng/kg.min of PGE1; (3) inhalation of 0.02‰ nitric oxide;(4) the combination of all three agents (blood hibernation group);and (5) no drugs (control group) during CPB. Plasma concentrations of sICAM-1 and vWF were measured before CPB (T1), 30min after the start of CPB (T2),at the end of CPB (T3),3h (T4) after termination of CPB and 24h (T5) after termination of CPB. The artery blood gas analysis was performed to calculate respiratory index (RI) and respiratory indexes at all time points were compared among 5
groups. Results The plasma concentrations of sICAM-1 and vWF were significantly lower in the blood hibernation group than those in the other4 groups (P＜0.01). The plasma concentrations of sICAM-1 and vWF after CPB were significantly increased compared with baseline values at T1 in group ulinastatin, PGE1, NO and control group(P＜0.01). Compared with the other 4 groups, the RI was significantly lower in the blood hibernation group (P＜0.01). Conclusion Blood hibernation can significantly inhibit the
concentrations of sICAM-1 and vWF, attenuate the lung injury in CPB and improve lung function. |
| Key words: Blood hibernation Infant Cardiopulmonary bypass Lung injury |
