脂微球化前列地尔对体外循环诱发小儿肺损伤的影响  

Effects of lipo-alprostadil on lung injury induced by cardiopulmonary bypass in children

作　　者：王文伟[1] 李军[1] 蒋懿斐[1] 倪育飞[1] 张文辉[2] 连庆泉[1] 

机构地区：[1]温州医学院附属第二医院麻醉科,325027 [2]温州医学院附属第一医院检验科

出　　处：《中华麻醉学杂志》2008年第9期814-816,共3页Chinese Journal of Anesthesiology

基　　金：浙江省医药卫生重点科技项目（2005ZD010）

摘　　要：目的评价脂微球化前列地尔对体外循环（CPB）诱发小儿肺损伤的影响。方法择期CPB下行先天性心脏病矫正术患儿27例，年龄100d～9岁，体重5～22kg，心功能Ⅰ或Ⅱ级，随机分为2组：对照组（C组，n＝12）和脂微球化前列地尔组（P组，n=15）。P组预充液中加入脂微球化前列地尔10ng／ml，麻醉诱导后即刻经中心静脉输注脂微球化前列地尔10ng·kg^-1·min^-1至术毕，C组给予等容量生理盐水。于CPB开始前即刻（T1）、主动脉开放后30min（T2）、2h（T3）、6h（T4）及24h（T5）时取桡动脉血样，行动脉血气分析及中性粒细胞（PMN）计数，采用酶联免疫吸附法测定血浆白细胞介素6（IL-6）、IL-8、IL-10、肿瘤坏死因子α（TNF-α）和基质金属蛋白酶-9（MMP-9）的浓度；计算动态肺顺应性（Cd）、氧合指数（OI）、肺泡-动脉氧分压差（A-aDO2）及呼吸指数（RI）。结果与C组比较，P组OI升高，RI、A-aDO2、血浆IL-6、IL-8、TNF-α、IL-10、MMP-9浓度及PMN计数降低（P〈0．05或0．01）。结论脂微球化前列地尔可减轻CPB诱发的小儿肺损伤，可能与其减轻肺组织炎性反应有关。Objective To investigate the effects of lipo-alprostadil on lung injury induced by cardiopulmonary bypass （CPB） in children. Methods Twenty-seven ASA Ⅰ or Ⅱ children aged 100 d-9 yr weighing 5-22 kg undergoing elective cardiac surgery under CPB were randomly divided into 2 groups： control group （C, n = 12） and lipo-alprostadil group （P, n = 15）. In group P lipo-alprostadil 10 ng/ml was added to the priming solution and infused via CVP line at 10ng·kg^-1·min^-1 immediately after induction of anesthesia until the end of operation, Group C received equal volume of normal saline instead of lipo-alprostadil. Blood samples were obtained from radial artery immediately before CPB （T1 ）, at 30 rain （T2）, 2 h （T3）, 6 h （ T4 ） and 24 h （T5） after aortic unclamping for blood gas analysis, PMN count and determination of plasma IL-6, 1L-8, IL-10, TNF-α and MMP-9 concentrations （ by ELISA ）. Alveolar-arterial oxygen gradient （ A-aDO2 ）, oxygenation index （OI）, dynamic ,lung compliance （Cd） and respiratory index （RI） were calculated. Results OI was significantly higher while RI, A-aDO2, the plasma concentrations of IL-6, IL-8, TNF-α, IL-10, MMP-9 and PMN count were lower in group P than in group C. Conclusion Lipo-alprostadil can ameliorate lung injury induced by CPB in children by reducing inflammatory response of the lung tissue.

关 键 词：前列地尔 心肺转流术 呼吸窘迫综合征 成人 儿童 

分 类 号：R726[医药卫生—儿科]