乌司他丁对重度紫绀型先天性心脏病患儿的心肺保护作用  

Cardiopulmonary Protective Effects of Ulinastatin in Children with Severe Cyanosis Congenital Heart Disease

作　　者：王显悦[1] 张本[1] 董文鹏[1] 毕生辉[1] 童光[1] 王晓武[1] 马涛[1] 张卫达[1] 

机构地区：[1]广州军区广州总医院(第二军医大学临床医学院)心脏外科中心,广东广州510010

出　　处：《华南国防医学杂志》2016年第5期301-304,共4页Military Medical Journal of South China

基　　金：国家自然科学基金项目(81500298;81400223);广东省自然科学基金项目(2014A030310473);广州市科技计划项目(2011J4100021)

摘　　要：目的观察乌司他丁对重度紫绀型先天性心脏病患儿的心肺保护作用。方法将2010-06/2015-06月于作者科室行根治手术治疗的60例重度紫绀型先天性心脏病患儿随机分为乌司他丁组和对照组,每组30例。乌司他丁组体外循环(cardiopulmonary bypass,CPB)时使用乌司他丁20 000 U/kg,术后3 d每日使用乌司他丁20 000 U/kg。对照组同期使用生理盐水。比较两组患儿临床指标:手术时长、CPB时间、心脏停跳时间、手术结束时动脉血压和中心静脉压、监护室治疗时间、术后住院时长、血管活性药物使用情况,术后血气分析指标:动脉血氧分压(arterial partial pressure of oxygen,Pa O2)和二氧化碳分压(partial pressure of carbon dioxide,Pa CO2),气道压力峰值(airway pressure peak,Ppeak)以及术后机械通气时长和肺部感染例数。结果两组手术效果尚满意,乌司他丁组患儿死亡1例(总死亡率1.6%),两组患儿手术时长、CPB时间、心脏停跳时间和术中心脏复跳情况及术后住院时长无统计学差异。与对照组比较,乌司他丁组患儿CPB超滤后动脉血压高、中心静脉压低,术后血管活性药物使用较少,监护室治疗时间短(P均<0.05)。两组患儿术后动脉血血气分析PCO2无明显差异。乌司他丁组患儿Pa O2高,Ppeak较低,术后机械通气时间较短,肺部感染发生例数少。结论乌司他丁能够安全用于重度紫绀型先天性心脏病患儿围手术期治疗,对患儿心肺功能具有保护作用。Objective To investigate the cardiopulmonary protective effects of ulinastatin in children with severe cyanosis congenital heart disease undergoing radical surgery under cardiopulmonary bypass. Methods From June 2010 to June 2015,60 children with severe cyanosis congenital heart disease scheduled for radical surgery were randomly divided into ulinastatin group（ n = 30） and control group（ 30 cases）. ulinastatin patients received 20 000 U / kg of ulinastatin in prime solution for cardiopulmonary bypass,and the same dose of ulinastatin per day for 3 days after surgery. Control children received equal volume of saline at the same timepoints. The peri-operative parameters,such as operating time,cardiopulmonary bypass time,cardiac arrest time,ICU time,post-operative length of stay,mean arterial pressure（ MAP） and central venous pressure（ CVP） immediately after modified ultrafiltration,post-operative inotropic scores,arterial partial pressure of oxygen（ Pa O2）,partial pressure of carbon dioxide（ Pa CO2） and peak pressure of airway（ Ppeak） upon ICU arrival,ventilation time,ICU time and post-operative pulmonary infections were recorded. Results One case died in ulinastatin group. There was no statistical difference between the two groups as to operating time,cardiopulmonary bypass time,cardiac arrest time,ICU time and the ratio of spontaneous rhythm recovery after aortic crossclamp removal.Compared with control group,patients in ulinastatin group had higher MAP,lower CVP right separation from modified ultrafiltration and shorter post-operative length of stay. The post-operative inotropic scores in ulinastatin group were sig nificantly reduced compared with control patients（ P 〈 0. 05）. There was no statistical difference between the two groups in the values of Pa CO2. Ulinastatin patients had higher value of Pa O2,lower Ppeakin the same ventilation condition. There were significantly less pulmonary infections in ulinastatin patients（ 2 /20） compared with control patients（ 8 /20）.

关 键 词：乌司他丁 紫绀型先天性心脏病 小儿 

分 类 号：R541.1[医药卫生—心血管疾病]