七氟烷预处理在婴幼儿体外循环中对肺功能的保护作用  

Protective effect of sevoflurane pretreatment on lung function of infants during cardiopulmonary bypass

作　　者：陈芳[1] 马星钢[1] 孟保英[2] 赵雷[3] 

机构地区：[1]广东省深圳市儿童医院麻醉科,广东深圳518038 [2]广东省深圳市儿童医院心胸外科,广东深圳518038 [3]暨南大学第二临床医学院广东省深圳市人民医院麻醉科,广东深圳518020

出　　处：《吉林大学学报（医学版）》2016年第4期793-797,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81401570)

摘　　要：目的:观察七氟烷预处理在婴幼儿体外循环(CPB)心脏直视手术中对肺功能的影响,探讨其肺保护作用及可能机制。方法:选择1岁以内行室间隔缺损修补术的患儿60例,按照随机数字表法分为预处理组和对照组(n=30)。预处理组患儿在全身麻醉诱导完成气管插管后开始持续吸入1.0最小肺内浓度(MAC)七氟烷,直至CPB开始;对照组患儿不吸入七氟烷。记录2组患儿的呼吸机支持时间,比较2组患儿在主动脉阻断前(T0)、主动脉开放30min(T1)、CPB结束后2h(T2)和CPB结束后6h(T3)4个时间点气道平台压(Pplate)、肺顺应性(CL)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)、呼吸指数(RI)及肺隔离白细胞和中性粒细胞计数。结果:与对照组比较,预处理组患儿呼吸机支持时间明显缩短(P<0.05)。与T0时间点比较,2组患儿在T1、T2和T3时间点CL和OI均明显降低(P<0.05或P<0.01),Pplate、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显升高(P<0.05或P<0.01)。与对照组比较,在T1、T2和T3时间点预处理组患儿CL和OI均明显升高(P<0.05或P<0.01),Pplate、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显降低(P<0.05或P<0.01)。结论:在婴幼儿CPB手术中应用七氟烷预处理可以减少白细胞的黏附,保护患儿的肺功能,值得临床推广应用。Objective：To observe the influence of sevoflurane pretreatment in the lung function of the infants during heart operation by cardiopulmonary bypass（CPB）,and to explore its lung protection and possible mechanism.Methods：Sixty infants with ventricular septal defect were enrolled at age less than 1year old and randomly assigned to pretreatment group and control group（n=30）.After the induction of general anesthesia and tracheal intubation,the patients in pretreatment group received continuous inhalation of 1.0 MAC sevoflurane until the beginning of CPB.Inhale sevoflurane was absent in control group.The duration of ventilator support of the infants in two groups was recorded.The Pplate,CL,OI,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung of the patients were compared between two groups at the four time points T0（before aorta clamping）,T1（30min after aorta declamping）,T2,and T3（2hand 6hafter CPB）.Results：Compared with control group,the duration of ventilator support of the infants in pretreatment group was obviously shortened（P〈0.05）.In each group,the CL and OI were significantly decreased（P〈0.05 or P〈0.01）,while the Pplate,A-aDO2,RI,the number of leukocyte and neutrophils segregated in lung were significantly increased（P〈0.05 or P〈0.01）at T1,T2,T3 time points compared with T0 time point.The CL and OI in pretreatment group were significantly increased（P〈0.05 or P〈0.01）;the Pplate,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung in pretreatment group were significantly decreased at T1,T2,and T3（P〈0.05 or P〈0.01）compared with control group.Conclusion：Sevoflurane pretreatment might play a role in decreasing the leukocyte adhesion and protecting the lung function in the infants during opening heart operation by CPB.

关 键 词：七氟烷 婴幼儿 体外循环 肺保护 

分 类 号：R614.2[医药卫生—麻醉学] R654.1[医药卫生—外科学]