吸入一氧化氮对婴幼儿体外循环中肺功能及肺表面活性物质的影响  

Protective effects of inhaling low doses NO on pulmonary function and pulmonary surfactant during cardiopulmonary bypass in infants

作　　者：刘海波[1] 杨顺章[1] 吴伟平[1] 张志孟[1] 张光磊[2] 

机构地区：[1]福建医科大学附属泉州第一医院心外科,福建省362000 [2]泉州市儿童医院小儿外科

出　　处：《中国心血管病研究》2009年第4期290-292,共3页Chinese Journal of Cardiovascular Research

基　　金：福建泉州市科技计划项目课题（2005Z14）

摘　　要：目的探讨吸入一氧化氮（NO）对婴幼儿体外循环中肺功能及肺表面活性物质的影响。方法将30例室间隔缺损患儿随机分为对照组和NO组。NO组在体外循环期间吸入40ppmNO直至关胸。体外循环前和术后气管插管未拔前0-1h，1-2h，2-3h测定气道压、吸入氧浓度和呼气末二氧化碳浓度（ETCO2），并分别在同时点采动脉血进行血气分析，计算肺泡死腔率（VD／VT）、肺泡动脉血氧分压差（P（A—a）O2）、动脉血氧含量（CaO2）和肺泡氧合指数（OI），记录术后呼吸机支持时间。体外循环前、主动脉开放后1、5、10min以少量生理盐水灌洗气道，分别测定气道吸出物（BAL）中总磷脂（TPL）、饱和卵磷脂（SatPC）、总蛋白（TP）值，计算SatPC／TPL（％）、SatPC／TP（mg／g）。结果与对照组相比，NO组VD／VT、P（A—a）O2、OI明显下降（0．43±0．22比0．73±0．16，81．9±31．6比102．6±36．4，1．25±0．12比1．89±0．13，P〈0．01），CaO2升高（16.31±1．57比14．16±1．58，P〈0．01）；两组的SatPC／TPL、SatPC／TP，CPB后较CPB前明显降低（25．81±4．1比46．3±5．16，20．14±7．42比61．05±6．17，35．51±5．1比43．90±4．61，30．14±4．42比58．92±6．92，P〈0．01）。NO组SatPC／TPL和SatPC／TP下降的幅度明显小于对照组（47．52±2．75比（37．72±3．71，51．67±6．07比40．87±7．07，P〈0．01）。结论婴幼儿体外循环术中存在明显的肺损害，表现为一些亚临床性肺功能损伤。吸入40ppmNO对体外循环期间肺功能有保护作用。Objective To study the effects of inhaling Nitric Oxide（NO） on pulmonary function and pulmonary surfactant during cardiopulmonary bypass in infants. Methods Thirty infants with congenital heart disease were randomly divided into control group （ n=15 ） and NO group（n=15）. Before CPB and After operation 0-1 h, 1-2 h,2-3 h,the cases of NO group inhaled 40 ppm NO till the operation finished. The following factors： mean pulmonary ＇arterial pressure （ MPAP ）, fractional concentration of inspired oxygen （FiO2）, End-tidal CO2（ET-CO2）, the value of volume of dead air space/tidal volume（VD/VT）, Oxygen Index （OI）, alveolar-arterial PO2 diff -erence （P （A-a）O2） and Oxygen content in arterial blood （CaO2） were calculated to evaluating pulmonary function. Before CPB and 1,3,5,10 min after aortic declamping, tube was lavemented by litter NS in each phase point,the level of TPL, SatPC, TP were determinted, the value of SatPC/TPL and SatPC/TP were calculated. Results The VD/VT,P （A-a）O2,OI in control group were much higher than those in NO group,and CaO2 in No group were higher than that in control group（P〈0.01 ）. The level of SatPC/TPL, SatPC/TP at postoperation were lower than those before CPB （P〈0.01）, and the decending formant of SatPC/TPL and SatPC/TP in control group was higher than that in NO group. Conclusion Lung ischemia-reperfusion injury is obviously during cardiopulmonary bypass in infants, and manifested itself in sub-clinical pulmonary function injury, Inhale 40 ppm NO shows protective effects on lung injury during CPB in infants.

关 键 词：体外循环 肺功能 肺表面活性物质 一氧化氮 

分 类 号：R654.2[医药卫生—外科学]