前列腺素E_1、山莨菪硷和复方红景天对体外循环肺损伤的防治作用  

Prevention and treatment of lung injury during cardiopulmonary bypass with prostaglandin E_1, anisodamine and composite rhodiolae*

作　　者：徐克劲[1] 李庆新[1] 宿华伟[1] 董书强[1] 陈立军[1] 

机构地区：[1]兰州军区兰州总医院心血管外科,甘肃兰州730050

出　　处：《中国现代医学杂志》2004年第24期84-87,共4页China Journal of Modern Medicine

基　　金：总后卫生部提供的军队"九五"医药卫生科研基金赞助项目(96D044)

摘　　要：目的结合118例患者的处理,探讨重症心脏病患者在体外循环心脏手术时肺损伤的防治方法。方法入选的病例系合并重症肺动脉高压或联合心瓣膜病变,分为前列腺素E1和山莨菪硷治疗组、复方红景天治疗组及对照组。它们的一般处理,包括术前常规用药、手术操作等是相同的。前列腺素E1和山莨菪硷治疗组(17例)于术中、术后另给予前列腺素E1 0.1～0.2μg/kg·min和山莨菪硷20～30μg/kg·min(术后);红景天治疗组(40例)手术前、后另加复方红景天胶囊,4 g/d,儿童用量减半;对照组(61例)未加其它药。收集患者入院当日、术后24 h的动脉血气资料及术后通气参数、呼吸机辅助时气道阻力进行统计分析。结果应用前列腺素E1加山莨菪硷、复方红景天两组血气及通气指标均优于对照组,P<0.05或P<0.01。急性肺损伤发生率分别为5.9%(1/17),7.5%(3/40)和18.0%(11/61);死亡率分别为0.0%(0/1),0.0%(0/3)和45.5%(5/11)。结论前列腺素E1、山莨菪硷及中药复方红景天在防治体外循环并发急性肺损伤方面有较好的作用。Objective: To explore the lung protection method for serious heart disease during cardiac surgery. Methods: There were 118 patients with pulmonary vasculature disease combined serious heart disease entered into this experiment preoperative management and operative procedure were similar. The patients were divided into three groups. Group 1 (n =17) was treated with prostaglandin E1 (PGE1, 0.1～0.2 μg/kg·min) and anisodamine (20～30 μg/kg·min) during and after operation, group 2 (n =40) took composite rhodiolae (CR) at doses of 4 grams (for adults) or 2 grams (for children) every day before and after operation, and group 3 (n =61) was treated with routine medicines. Arterial blood gas (ABG), ventilation parameters and airway resistance were detected before operation and 24 hours later post-operation. Results: The values of ABG and ventilation parameters in group 1 and group 2 had much better results than those in group 3 (P <0.05 or P <0.01). The morbidity of lung injury in three groups was 5.9% (1/17), 7.5% (3/40) and 18.0% (11/61) respectively, and the mortality in three groups was 0.0%, 0.0% and 45.5% respectively. Conclusion: It may be a good method to prevent and treat acute lung injury with prostaglandin E1 and anisodamine or composite rhodiolae during cardiopulmonary bypass.

关 键 词：肺损伤 肺保护 体外循环 

分 类 号：R542.5[医药卫生—心血管疾病] R563.9[医药卫生—内科学]