法洛四联症根治术中经肺动脉灌注低温保护液的肺保护作用

[Lung protection by perfusion with hypothermic protective solution to pulmonary artery during total correction of tetralogy of Fallot].

作者信息

Wei Bo, Liu Yinglong, Wang Qiang, Chang Yongnan, Li Chunhua

机构信息

Department of Congenital Heart Defect, Fuwai Heart Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2002 Sep;40(9):685-8.

PMID:12411141

Abstract

OBJECTIVE

To study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot (TOF).

METHODS

Sixty-four consecutive children with TOF were randomly divided into control group (n = 30) and lung protective group (n = 34). The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery. Patients in the control group were subjected to routine approach. Patients' hemodynamics and lung functions were monitored. Plasma malondialdehyde (MDA), TNF-alpha and IL-6, IL-8 in tracheal suction were measured. Lung biopsy specimens were obtained after operations to study histological changes.

RESULTS

The oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation (t = 2.400, P < 0.05; t = 3.898, P < 0.01; t = 3.339, P < 0.01, respectively). The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group (t = -2.652, P < 0.05; t = -2.081, P < 0.05). The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations (t = -4.255, P < 0.01; t = -2.372, P < 0.05 respectively). The level of TNF-alpha was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation (t = 3.112, P < 0.01; t = 3.072, P < 0.01; t = 2.306, P < 0.05, respectively). The levels of IL-6, IL-8 in tracheal suction were lower in the lung protective group (t = -2.419, P < 0.05; t = -2.613, P < 0.01). Tissue examination showed intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group.

CONCLUSION

Perfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF.

摘要

目的

研究在法洛四联症（TOF）根治术中经肺动脉灌注低温保护液的肺保护作用。

方法

64例连续性TOF患儿随机分为对照组（n = 30）和肺保护组（n = 34）。肺保护组的肺保护方法是经肺动脉灌注低温保护液。对照组采用常规方法。监测患者的血流动力学和肺功能。检测血浆丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）以及气管吸出物中的白细胞介素-6（IL-6）、白细胞介素-8（IL-8）。术后获取肺活检标本以研究组织学变化。

结果

术后6小时、12小时和24小时，肺保护组的氧合指数高于对照组（t分别为2.400，P < 0.05；t为3.898，P < 0.01；t为3.339，P < 0.01）。肺保护组在重症监护病房（ICU）的时间和机械通气时间显著短于对照组（t分别为 -2.652，P < 0.05；t为 -2.081，P < 0.05）。术后0小时和6小时，肺保护组的MDA水平低于对照组（t分别为 -4.255，P < 0.01；t为 -2.372，P < 0.05）。术后0小时、6小时和24小时，肺保护组的TNF-α水平低于对照组（t分别为3.112，P < 0.01；t为3.072，P < 0.01；t为2.306，P < 0.05）。肺保护组气管吸出物中的IL-6、IL-8水平较低（t分别为 -2.419，P < 0.05；t为 -2.613，P < 0.01）。组织学检查显示，对照组出现肺泡内水肿、毛细血管充血、白细胞聚集以及线粒体肿胀，而肺保护组无变化。