前列地尔联合乌司他丁对小儿体外循环后炎性反应和肺损伤的影响  

Effects of alprostadil and ulinastatin on inflammatory response and lung injury after cardiopulmonary bypass in pediatric patients with congenital heart diseases

作　　者：蒋懿斐[1] 王文伟[1] 叶文炼[1] 倪育飞[1] 李军[1] 陈小玲[1] 金胜威[1] 连庆泉[1] 

机构地区：[1]温州医学院附属二院育英儿童医院麻醉科,325027

出　　处：《中华医学杂志》2008年第41期2893-2897,共5页National Medical Journal of China

基　　金：浙江省医药卫生重点科技基金资助项目（2005ZD010）

摘　　要：目的观察前列地尔和（或）乌司他丁（Ulinastatin）对小儿体外循环后炎性反应的影响及其肺保护作用。方法选择择期行体外循环下房室缺修补术患儿58例。随机分为4组：对照组（C组14例）、前列地尔组（P组15例）、乌司他丁组（U组15例）、前列地尔联合乌司他丁组（Pu组14例）。观察患儿血流动力学变化，总机械通气时间和ICU留治时间。麻醉诱导后CPB前（T1）、主动脉开放30min（T2）、2h（T3）、6h（T4）、24h（T5）5个时点采集桡动脉血测量中性粒细胞（PMN），血浆中白细胞介素（IL）-6、IL-8、IL-10、肿瘤坏死因子（TNF）-α和基质金属蛋白酶-9（MMP-9）的含量。于T1、T2、T3记录吸入氧浓度和动脉血气计算肺泡氧合指数（OI）。结果与C组比较，其他3组在T2、T3时PMN、IL-6、IL-8、TNF-α的水平明显降低（均P〈0．05），其中PU组最低。U组、PU组患儿血浆IL-10水平在T2、T3明显高于C组，而MMP-9水平明显低于C组（均P〈0．05），P组则与C组差异无统计学意义。在T2时其他3组0I值明显高于C组（均P〈0．05）。PU组机械通气时间明显短于C组（P〈0．05）。结论CPB中同时使用前列地尔和乌司他丁可减轻体外循环后炎性反应从而保护肺功能。Objective To investigate the therapeutic effects of alprostadil （Lipo-PGE1） and Ulinastatin on inflammatory response and lung injury after cardiopulmonary bypass （CPB） in pediatric patients with congenital heart diseases. Methods 58 children with congenital heart diseases, including atrial septal defect,ventricular septal defect, and atrioventricular septal defect, scheduled to undergo CPB, aged 4-72 months, were randomly divided into 4 groups： alprostadil Group P （n = 15 ） receiving alprostadil 10 ng/ml added into the prime solution and continuous pump infusion of alprostadil 10 ng· kg^-1·min^-1 via central vein until the end of operation, Group U （ n = 15 ） receiving ulinastatin 20 000 U/kg divided into several doses to be added into the prime solution, Group PU （ n = 14 ） receiving alprostadil and ulinastatin according to the above protocols, and Group C （ control group, n = 14） receiving normal saline of the equal volume. Electrocardiogram （ECG） ,heart rate （HR）, pulse oxygen saturation （SpO2 ）, and mean arterial pressure （MAP） were continuously monitored during operation. Duration of mechanical ventilation and staying in ICU were also recorded. Plasma neutrophil （PMN）, IL-6, IL-8, IL-10, tumor necrosis factor （TNF）-ct and matrix metalloproteinase （MMP-9） levels in the radial arterial blood samples were measured after induction of anesthesia before CPB （T1） ,30 minutes and （T2 ） ,2 hours （ T3 ） ,6 hours （T4 ）, and 24 hours （ T5 ） after the declamping of aorta. Inhaled oxygen concentration and arterial blood gas analysis were recorded at T1 , T2 , and T3 for calculation of oxygenation index （OI）. Results There were no significant differences in the MAP and HR among these four groups at any time points （ all P 〉 O. 05）. The umbers of PMN and the levels of IL-6, IL-8, and TNF-α at T2 and T3 of Groups P, U, and PU were all significantly lower than that of Group C （all P 〈0.05） ,with those of Group PU being the lowest. The

关 键 词：体外循环 儿童 麻醉 前列地尔 乌司他丁 

分 类 号：R686[医药卫生—骨科学]