摘要
目的 研究肺动脉灌注低温保护液减轻体外循环肺内炎性反应的作用。方法 4 0例行法洛四联症 (TOF)根治术的病儿随机分为肺保护组 2 0例 ,对照组 2 0例。肺保护组体外循环期间肺动脉灌注低温肺保护液 ,对照组行常规TOF根治术。围手术期监测血浆肿瘤坏死因子 (TNF α)水平。收集术后6h气管吸出物 ,检测其中炎性介质白细胞介素 (IL) 6、IL 8水平。征得病儿家属同意 ,术后取右下肺组织活检 ,观察组织内炎性反应情况。同时监测围手术期肺功能及临床指标。结果 肺保护组血浆中TNF α水平低于对照组 ,以回ICU 0h、2 4h差异显著 (P <0 0 1、P <0 0 5 ) ;术后 6h内气管吸出物中IL 6和IL 8水平肺保护组低于对照组 (P <0 0 1) ;肺组织活检对照组可见中性粒细胞浸润 ,肺保护组无明显病理改变。肺保护组术后肺泡 -动脉氧分压差 (A aO2 )较对照组低 ,以回ICU 0h、12h和 2 4h差异显著(P <0 0 5、P <0 0 1和P <0 0 5 ) ;肺保护组呼吸机辅助通气时间短于对照组 (P <0 0 1)。结论 肺动脉灌注低温保护液可明显减轻体外循环中肺内的炎性反应和改善肺功能。
Objective: To evaluate the effect of perfusion of pulmonary artery using hypothermic protective solution on the inflammatory response of lung during cardiopulmonary bypass. Methods: 40 children with TOF were divided into control group (n=20) and protective group (n=20). The basic parameters (age, weight, C/T ratio, oxygen saturate) were not different between both groups. In control group, the operation was performed using routine approaches. While in protective group pulmonary artery were infused with 4℃ protective solution during CPB. Plasma TNF-α, IL-6 and IL-8 of tracheal suction was measured. Lung biopsy specimens were obtained after operations for study on histological changes. At same time, patients' pulmonary functions and clinic index were monitored. Results: TNF-α was lower in protective group when compared with control group immediately and at 24h after operations (P<0.01,P<0.05). IL-6 and IL-8 of tracheal suction were less in protective group (P<0.01). Tissue examination showed that leukocytes accumulated in the control group, whereas no pathologic change was found in protective group. A-a O_2 in protective group was lower than that in control group at 6h and 24h after operations (P<0.05, P<0.01, P<0.05). The time of mechanical ventilation was significantly shorter in protective group than that in control group (P<0.01). Conclusion: Perfusion with hypothermic protective solution to pulmonary artery during CPB could reduce the inflammatory response of lung and improve pulmonary function.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2004年第1期4-6,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
