经升主动脉注射鱼精蛋白的肺保护作用  

Lung protection effect of intra-aortic protamine injection in infants underwent opening heart operation by cardiopnimonary bypass surgery

作　　者：孟保英[1] 张青[1] 王涛[1] 沈定荣[1] 彭乐[1] 马超[1] 潘晓兰[1] 王元祥[1] 

机构地区：[1]广东省深圳市儿童医院心血管科,518026

出　　处：《中国综合临床》2011年第3期235-238,共4页Clinical Medicine of China

基　　金：深圳市科技计划项目（200802063）

摘　　要：目的探讨经升主动脉注射鱼精蛋白对婴幼儿体外循环心脏直视手术的肺保护作用。方法60例（年龄≤1岁，体重≤10kg）行体外循环心脏直视手术患儿，随机分为升主动脉组和中心静脉组各30例，比较2组注射鱼精蛋白前和注射鱼精蛋白后10min、1h、3h气道峰压（Ppeak）、气道平台压（Pplate）及肺顺应性（CL）、氧合指数（OI）、肺隔离白细胞、中性粒细胞计数和术后呼吸机辅助通气时间的差异。结果在注射鱼精蛋白1、3h后，升主动脉组肺隔离白细胞、中性粒细胞计数、Ppeak、Pplate较中心静脉组明显减低（t值分别为2．743、3．512，3．218、3．469，3．716、5．243，3．853、4．783，P均〈0．05），升主动脉组CL及OI较中心静脉组明显增高（t值分别为3．976、4．267，4．557、4．265，P均〈0．05）；升主动脉组较中心静脉组呼吸机辅助通气时间明显缩短[（8．03±5．14）、（10．56±6．95）h，t=2．599，P〈0．05]。结论经升主动脉注射鱼精蛋白能够减轻体婴幼儿体外循环心脏直视手术肺损伤，是一种良好的肺保护措施。Objective To study the protective effect of intraaortic protamine injection on lung in infants undergwent opening heart operation by cardiopulmonary bypass surgery. Methods Sixty infants （ age ≤ 1 year, weight ≤ 10 kg）who accepted opening heart operation by cardiopulmonary bypass surgery were randomly assigned into 2 groups （ n = 30 in each group） reciving intra-aortic and intra-venous protamine injection respectively. P- peak, P-plate, CL, Oxygenation Index, the number of WBC and neutrophil segregated in lungs were compared between two groups before injecting protamine and 10 minutes, 1 hour, 3 hours after injecting protamine. The time of mechanical ventilation were compared as well. Results P-peak, P-plate, the number of WBC and neutrophil segregated in lungs of intra-aortic injection group significantly decreased than intra-venous injection group at 1 hour, 3 hours after injecting protamine （t =2. 743, 3.512; 3. 218, 3.469; 3.716, 5. 243; 3. 853, 4. 783 respectively, Ps 〈 0. 05 ）, while the CL and Oxygenation Index increased significantly （ t = 3. 976, 4. 267; 4. 557,4. 265 respectively, P 〈0. 05 ）. The duration of mechanical ventilation follow operation in intra- aortic injection group （ [ 8. 03 ± 5.14 ] h ） was shorter compared with intra-venous injection group （ [ 10. 56 ± 6.95 ] h） （ t = 2. 599, P 〈 0. 05 ）. Conclusion By intra-aortic protamine injection the lung injury decreased significantly. It shows good protective effect on lung in infants underwent opening heart operation by cardiopulmonary bypass surgery.

关 键 词：体外循环 肺损伤 鱼精蛋白 婴幼儿 

分 类 号：R654.2[医药卫生—外科学]