Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2010 Oct;123(19):2645-50.
Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a novel adjunctive method, which can minimize the lung ischemic-reperfusion injury and inflammatory response. This study evaluated the protective effect of pulmonary perfusion with hypothermic HTK solution in corrections of congenital heart defects with pulmonary hypertension.
Between June 2009 and December 2009, 24 consecutive infants with congenital heart defects and pulmonary hypertension were randomly divided into perfused group (n = 12) and control group (n = 12). Oxygen index, alveolar-arterial O2 gradient, serum levels of malondialchehyche (MDA), interleukin (IL)-6, -8, -10, soluble intercellular adhesion molecule-1 (sICAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.
Oxygenation values were better preserved in the perfused group than in the control group. The serum levels of IL-6 increased immediately after CPB in both groups and returned to baseline at 48 hours after CPB,but it was restored faster and earlier in the perfused group. The serum levels of IL-8, sICAM-1, and MDA remained at baseline at each point after CPB in the perfused group and elevated significantly immediately after CPB in the control group, except for sICAM-1. The serum level of IL-10 increased immediately after CPB and decreased to baseline at 48 hours after CPB in both groups, but the IL-10 level in the perfused group was significantly higher than in the control group at 12 hours after CPB. The serum P-selectin levels in the control group immediately after CPB were significantly higher than prebypass levels. Moreover, there were no significant differences in postoperative clinical characters, except for the intubated time.
In infants with congenital heart defects, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass could ameliorate lung function and reduce the inflammatory response.
体外循环（CPB）期间的肺动脉灌注是一种新的辅助方法，可以最大程度地减少肺缺血再灌注损伤和炎症反应。本研究评估了低温 HTK 溶液肺灌注在纠正伴有肺动脉高压的先天性心脏缺陷中的保护作用。
2009 年 6 月至 2009 年 12 月，连续 24 例患有先天性心脏缺陷和肺动脉高压的婴儿被随机分为灌注组（n = 12）和对照组（n = 12）。在 CPB 开始前和结束后 48 小时内，分别测量氧指数、肺泡-动脉氧梯度、血清丙二醛（MDA）、白细胞介素（IL）-6、-8、-10、可溶性细胞间黏附分子-1（sICAM-1）和 P-选择素的水平。
灌注组的氧合值保存优于对照组。两组 CPB 后 IL-6 水平立即升高，CPB 后 48 小时恢复至基线，但灌注组恢复更快更早。CPB 后，灌注组血清 IL-8、sICAM-1 和 MDA 各时间点均保持在基线水平，对照组除 sICAM-1 外，CPB 后立即显著升高。CPB 后两组 IL-10 水平立即升高，CPB 后 48 小时降至基线，但灌注组 IL-10 水平在 CPB 后 12 小时明显高于对照组。CPB 后对照组血清 P-选择素水平立即高于术前水平。此外，除插管时间外，术后临床特征无明显差异。
在患有先天性心脏缺陷的婴儿中，CPB 期间低温 HTK 溶液的肺灌注可以改善肺功能并减轻炎症反应。
