含乌司他丁低温肺保护液在法洛四联症体外循环术中的应用  

The protective role of hypothermic protective solution during surgey for the tetralogy of FaHot

作　　者：胡瑶琴[1] 张泽伟[2] 

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,310003 [2]浙江大学医学院附属儿童医院心胸外科,310003

出　　处：《中华胸心血管外科杂志》2010年第4期252-255,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：浙江省科技厅重点课题基金资助项目（2004c23016）

摘　　要：目的 探讨含乌司他丁（UTI）的低温肺保护液对婴幼儿法洛四联症体外循环肺内炎性反应的保护作用.方法 30例行法洛四联症（TOF）根治术病婴,随机分为肺保护组和对照组,各15例.术前有感染征象（白细胞〉12×10^9/L、体温〉38℃,C-反应蛋白〉8 mg/L）、有过敏史者除外.肺保护组心脏停跳同时肺动脉灌注低温肺保护液,对照组常规行TOF根治术.围术期监测血浆肿瘤坏死因子（TNF-α）、中性粒细胞CD11b的表达和髓过氧化物酶（MPO）,同时监测血气、肺功能及临床指标.结果 血清TNF-α水平肺保护组较对照组低,关胸后0、3 h差异有统计学意义,（11.15±2.47）pg/ml对（14.21±5.55）pg/ml、（12.01±2.69）pg/ml对（15.94±4.86）pg/ml.肺保护组新鲜全血中性粒细胞表面的CD11b平均荧光强度（MFI）水平关胸后3、6 h显著低于对照组,（126.23±36.05）对（156.98±48.34）、（137.27±38.85）对（173.27±67.43）.肺保护组MPO水平关胸后3、6、24 h显著低于对照组,（156.52±17.57）U/L对（178.45±35.68）U/L、（178.28±23.63）U/L对（224.66±49.66）U/L、（130.52±57.50）U/L对（96.50±14.49）U/L.肺保护组呼吸机辅助时间明显较对照组短,（17.60±6.39）h对（23.70±8.51）h.肺保护组肺泡-动脉氧阶差（A-aDO2）在关胸后3、6 h显著低于对照组（120.92±33.08）mm Hg（1 mm Hg=0.133 kPa）对（145.52±39.38）mm Hg、（74.76±40.16）mm Hg对（112.50±44.16）mm Hg.肺动态顺应性（Cdyn）在关胸后3、6 h肺保护组显著高于对照组（0.59±0.11）ml·cmH2O^-1·kg-1对（0.46±0.17）ml·cmH2O^-1·kg^-1、（0.67±0.09）ml·cmH2O^-1·kg^-1对（0.53±0.18）ml·cmH2O^-1·kg^-1.结论 肺动脉灌注含乌司他丁的低温肺保护液明显减轻体外循环术后肺的炎性反应,具有肺保护作用.Objective The incidence of acute pulmonary injury occurred after cardiopulmonary bypass for fallot tetrad has been high. The severity of pulmonary ischemia-reperfusion has been found to be reduced with ulinastatin （UTI） in the animal models and clinical practice. We evaluated the effect of pulmonary artery perfusion with a hypothermic protective solution containing ulinastatin on the inflammatory response in the lung during cardiopulmonary bypass. Methods 30 children with tetralogy of Fallot （TOF） were randomly assigned into control group and protective group, 15 cases in each group. Patients would be excluded if they had signs of infections, such as the white blood cell count was over 12000 per microliter, the temperature was above 38 centi-degree and the c-reaction protein was more than 8 mg/L. Operation with routine approaches was performed in the control group and the pulmonary artery was infused with 4℃ protective solution in the protective group while the heart stoped beating. Plasma tumor necrosis factor α （TNF-α） 、CD11b and Myeloperoxidase （MPO） were measured intraoperatively and postoperatively. Blood gas、pulmonary function and clinic index of the patients were also monitored. Results The level of TNF-α was lower in the protective group as compared with that in the control group immediately and 3 hours after closing the sternum [（11.15±2.47） pg/ml vs. （14.21 ±5.55） pg/ml, P〈0.05; （12.01 ±2.69） pg/ml vs. （15.94 ±4.86）pg/ml,P 〈0.01]. The MFI of CD11b was lower in the protective group as compared with that in the control group at 3 and 6 hoursafter closing the sternum （126.23±36.05 vs. 156.98±48.34, P〈0.05; 137.27±38.85 vs. 173.27±67.43, P〈0.05）. The level of MPO was lower in protective group as compared with that in the control group at 3 hours, 6 hours and 24hours after closing the sternum [（156.52±17.57）U/L vs.（178.45±35.68）U/L, P〈0.05; （178.28±23.63） U/L vs.（224.66±49.66）U/L, P〈0.01;（130.52±57.50）U/L vs. （96.50±

关 键 词：法洛氏四联症 心肺转流术 肺 再灌注损伤 灌注 局部 乌司他丁 

分 类 号：R726.5[医药卫生—儿科]