体外循环术中低温改良低钾右旋糖酣肺动脉灌注的肺保护作用  

Lung Protection of Pulmonary Artery Perfusion with Hypothermia Modified LPD Solution during Cardiopulmonary Bypass

作　　者：刘立明[1] 胡建国[1] 尹邦良[1] 周新民[1] 刘锋[1] 李建明[1] 易定武[1] 

机构地区：[1]中南大学湘雅二医院胸心外科

出　　处：《中国现代手术学杂志》2005年第2期110-113,共4页Chinese Journal of Modern Operative Surgery

基　　金：湖南省卫生厅科研基金资助课题(B2004-048)

摘　　要：目的　研究体外循环(cardiopulmanarybypass, CPB)期间低温改良低钾右旋糖酐(low patassiumdextran, LPD)溶液肺动脉灌注对心脏瓣膜置换病人的肺保护作用。　方法　30例行二尖瓣置换术病人随机分为两组:肺灌注组(15例),CPB术中一次性肺动脉灌注低温改良LPD液;对照组(15例)常规行二尖瓣置换术,未行灌注。分别于术前、CPB结束、手术结束、术后6h测算氧合指数(PaO2 /FiO2 )、肺静态顺应性变化。CPB停机后30min,取病人右上肺组织,观察组织形态学变化。　结果　肺灌注组病人CPB结束、手术结束、术后6h的氧合指数分别为(421±31)、(382±41)、(370±39)mmHg,肺静态顺应性分别为(30. 8±3. 6)、(29. 2±3. 3)、(29. 2±3. 1)ml/cmH2O,明显高于对照组的( 340±33), (321+38), (315±41)mmHg和(24. 2±3. 0)、( 21. 3±2. 8 )、( 19. 0±3. 0 )ml/cmH2O (P<0. 05 )。肺组织活检病理检查结果显示,对照组肺间质水肿明显,有大量炎性细胞浸润,肺灌注组无明显病理改变。　结论　CPB术后存在肺损伤,CPB中采用低温改良LPD液肺动脉灌注具有肺保护作用。Objective To study the lung protection of pulmonary artery perfusion with hypothermia modified low-potassium dextran(LPD) solution during cardiopulmonary bypass(CPB). Methods 30 cases underwent mitral valve replacement were randomly divided into control group (n=15) and lung perfusion group (n=15). The cases in the lung perfusion group were perfused with 4℃ modified LPD solution via the pulmonary artery during CPB. The cases in the control group were performed the routine procedure of mitral valve replacement without perfusion. Pulmonary functions were measured before surgery, at the end of CPB and at 0h, 6h after surgery. Lung biopsy specimens were obtained at 30min after CPB to observe the histological changes. Results The PaO 2/FiO 2 in the lung perfusion group were (421±31), (382±41), (370±39)mmHg, significantly higher than (340±33), (321±38), (315±41) mmHg in the control group at the end of CPB, and at 0h, 6h after surgery. And the lung compliance in the perfusion group were (30.8±3.6), (29.2±3.3), (29.2±3.1)ml/cmH 2O, significantly higher than (24.2±3.0), (21.3±2.8) and (19.0±3.0) ml/cmH 2O respectively in the control group ( P <0.05). Pathological examination showed more severe injuries in the control group than that in the lung perfusion group. Conclusion Pulmonary artery perfusion with hyporthermia modified LPD solution during CPB demonstrates the effect of lung protection.

关 键 词：体外循环 肺动脉 再灌注损伤 中低温 低钾右旋糖酣 CPB LPD 心脏瓣膜 

分 类 号：R654.2[医药卫生—外科学]