C3a、C5a、TXA2、LT表达在婴幼儿体外循环肺损伤中作用及改良超滤效果  

Expression of C3a, C5a, TXA2 ,LT in pulmonary injury of infant open heart surgery improved withthe modified ultrafiltration technique

作　　者：刘宏生[1] 杨宁[2] 褚衍林[1] 马黎明[1] 费忠化[1] 仇杰[1] 董海新[1] 

机构地区：[1]山东省心脏疾病诊疗重点实验室济宁医学院附属医院心脏外科中心, 山东省济宁272029 [2]济宁医学院附属医院体检中心

出　　处：《中国医师杂志》2013年第2期190-192,共3页Journal of Chinese Physician

摘　　要：目的探讨婴幼儿体外循环（CPB）术后肺损害机制及改良超滤肺功能保护效果。方法收集本院先天性心脏病患儿施行手术40例，根据患儿家长意愿是否采用改良超滤分为无改良超滤组（20例）和改良超滤组（20例），患儿家长均签署知情同意书。分别收集转流前及转流后不同时点所测定气道峰压、呼吸停顿压、潮气量、呼吸频率、吸人氧浓度和吸气比例，及所测量动脉血中C3a、C5a及血栓素（TXA，）、白三烯（LT）的浓度。结果两组患儿CPB后肺静态顺应性（Cstat）、氧合指数（OI）较术前降低，肺泡．动脉氧分压（AaDO2）增加（P〈0．05）；在T3、T4、T，时间改良超滤组的Cstat、OI高于无改良超滤组，AaD02低于无改良超滤组（P〈0．05）。C3a、C5a术后浓度立即降低，但两组差异无统计学意义（P〉0．05）；无改良超滤组TXA2、LT浓度术后升高；在T2、T3、L、T，时点改良超滤组的TXA2、LT低于无改良超滤组（P〈0．05）。结论术后肺功能损害可能与CPB术后补体激活及再灌注损伤（I／R）致肺毛细血管内皮损伤有关。血浆补体浓度减低可作为观察炎性反应及组织损害早期指标。改良超滤可通过迅速滤出水份，提高胶体渗透压及降低TXA2、LT浓度达到良好肺保护效果。Objective To study the mechanism of pulmonary injury and protective effect of modified ultrafiltration on lung function in infant open heart surgery. Methods According to the wishes of parents, 40 cases of congenital heart disease were divided into without modified uhrafihration control group （C） and modified ultrafihration group （ M）, and parents signed informed consent. The cardiopulmonary bypass （CPB） was used without uhrafihration in Group C, while with modified uhrafiltration in group M. The pneumodynamic parameters and C3a, C5a,TXA2, LT were measured at specific time points. Results The static pulmonary compliance （Cstat） and oxygen index （OI） were lower,and alveolar-arteria oxygen difference （ AaDO2 ） was higher after CPB in the two groups （ P 〈 0.05）. At T3,T4 and T5 time points, the Cstat and OI in Group M was higher than that in Group C ; AaDO2 in Group M was lower than that in Group C （ P 〈0. 05）. The levels of C3a and CSa were lower after CPBin the two groups; levels of TXA2 ,LT were higher after CPB in the C groups. At T2 ,T3 ,T4 and T5 time points,the TXA/and LT in Group M were lower than that in Group C （ P 〈 0. 05 ）. Conclusions The pulmonary injury in pediatric open heart surgery may be concerned with the the alexin（C3a,C5a） activation and I/R. The level of C3a and C5a was consideredearlier index of inflammatory reaction and pulmonary injury. Modified uhrafihration improves pulmonary function due to elevating coloid osmotic pressure and degrading the plasma level of TXA2, LT.

关 键 词：N 损伤 体外循环 副作用 婴儿 心脏缺损 先天性 外科学 超滤 补体C3a 分析 补体C5A 分析 血栓烷A2 血液 白三烯类 血液 

分 类 号：R726[医药卫生—儿科]