联合应用肺表面活性物质和保护性机械通气策略治疗婴幼儿体外循环后急性肺损伤  

Effects of combined exogenous pulmonary surfactant and protective lung mechanical ventilation strategy on acute lung injury induced by cardiopulmonary bypass in infants

作　　者：邢泉生[1] 韩俐[1] 曹倩[1] 荣佑宝[1] 李贞福[1] 孙波[2] 

机构地区：[1]青岛大学医学院附属医院心脏外科,266003 [2]复旦大学附属儿科医院研究所

出　　处：《中华实验外科杂志》2003年第9期849-851,共3页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金资助项目 (30 0 70 752 );国家卫生部优秀青年科技人才专项基金资助项目 (1 999BA2CKA1 );山东省自然科学基金资助项目 (2 0 0 0YC1 0 )

摘　　要：目的　探讨联合应用外源性肺表面活性物质 (PS)和保护性肺通气策略对体外循环后急性肺损伤 (ALI) /急性呼吸窘迫综合征 (ARDS)的治疗效应。方法　婴幼儿体外循环术后ALI/ARDS患者 16例 ,随机分为A和B两组 ,A组 9例采用保护性肺机械通气治疗 ;B组 7例在保护性肺通气治疗基础上经气管插管联合应用外源性PS(15 0mg/kg体重 )。观察两组患儿的临床转归 ,并监测 48h内肺动态顺应性 (Cdyn)、氧合指数 (OI)、血浆肿瘤坏死因子 (TNF α)的水平。结果与以往同类病例的治疗结果相比 ,本组患儿死亡率 (6.2 5 % )和并发症显著降低。在治疗后 48h内的各个时点 ,B组Cdyn显著高于A组 (P <0 .0 5 ) ,OI和TNF α的水平显著低于A组 (P <0 .0 5～0 .0 1)。结论　外源性PS与保护性肺通气具有协同作用 。Objective To assess the efficacy of combined exogenous pulmonary surfactant (PS) and protective lung mechanical ventilation strategy on acute lung injury (ALI) induced by cardiopulmonary bypass (CPB) in infants.Methods Sixteen infants with ALI/acute respiratory distress syndrome (ARDS) after CPB were randomly divided into two groups: group A and B group.Group A included 9 patients who received protective lung mechanical ventilation strategy as follows: small tidal volume (6～8 ml/kg),high PEEP (6～12 cm H 2O),limited peak pressure (<30～35 cm H 2O),permissive hypercapnia (PaCO 2≤60 mm Hg); Group B included 7 patients who received exogenous PS and the protective mechanical ventilation.Exogenous natural porcine PS (150 mg/kg) was dropped into the intracheal tube at beginning and 24 h during the treatment.The clinical results of two groups were observed,and lung compliance,oxygenation index,TNF-α of the blood were determined at different time points during the 48 h of treatment.Results In these patients,only one died (6.25 %) and another one infant had barotrauma in the early period of treatment.Comparison with our past similar patients indicated that the mortality and morbidity were remarkably declined.On the other hand,the dynamic lung compliance of group B was higher than that of group B (P<0.05).The oxygenation index in group B was significantly lower than that in group A (P<0.05).The level of TNFα in group B was lower than that in group A (P<0.05～ 0.01).Conclusion The combined use of exogenous PS and protective lung mechanical ventilation exerts synergetic therapeutic effect on the ALI/ARDS after CPB.

关 键 词：体外循环 急性肺损伤 婴幼儿 肺表面活性物质 保护性机械通气策略 治疗 

分 类 号：R726.5[医药卫生—儿科]