小儿主动脉弓手术中SACP与DHCA应用效果的比较及乌司他丁对脑损伤的影响

发布时间：2018-01-15 05:20

  本文关键词：小儿主动脉弓手术中SACP与DHCA应用效果的比较及乌司他丁对脑损伤的影响　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

  更多相关文章： 儿童 主动脉弓 心肺转流术 胰蛋白酶抑制剂 儿童 主动脉弓 脑损伤 心肺转流术

【摘要】：第一部分小儿主动脉弓手术中SACP与DHCA应用效果的比较 目的比较选择性顺行性脑灌注（selective antegrade cerebralperfusion，SACP）与深低温停循环（deep hypothermic circulatory arrest，DHCA）在小儿主动脉弓手术中的应用效果。 方法收集我院2008年1月至2011年7月53例在体外循环（cardiopulmonary bypass，CPB）下行主动脉缩窄（coarctation of aorta，CoA）或主动脉弓中断（interrupted aortic arch，IAA）合并心内畸形矫治术患儿的临床资料，统计其CPB时间、主动脉阻断时间、DHCA或SACP时间、手术时间、最低鼻咽温、最低直肠温等CPB转流情况，及术后24h尿量、术后24h胸腔引流量、正性肌力药物得分、清醒时间、机械通气时间、ICU停留时间、死亡、神经系统并发症发生情况、急性肾功能衰竭发生情况、低心排出量综合征发生情况。根据术中采用的脑保护方法将53例患儿分为DHCA组（n=23）和SACP组（n=30），对其术中体外循环转流情况和术后恢复情况进行比较。 结果与DHCA组比较，，SACP组转流中最低鼻咽温和最低直肠温显著升高（P0.05），术后24h胸腔引流量、术后机械通气时间、术后ICU停留时间显著降低（P0.05）。两组死亡率、神经系统并发症、急性肾功能衰竭和低心排出量综合征发生率比较差异无统计学意义（P0.05）。 结论小儿主动脉弓手术中SACP与DHCA的脑保护效果相似。SACP有利于术后呼吸功能的恢复，减少术后出血和ICU停留时间。 第二部分乌司他丁对体外循环下主动脉弓手术患儿脑损伤的影响 目的评价乌司他丁对体外循环（cardiopulmonary bypass，CPB）下主动脉弓手术患儿脑损伤的影响。 方法选择拟在CPB下行主动脉缩窄（coarctation of aorta，CoA）或主动脉弓中断（interrupted aortic arch，IAA）合并心内畸形矫治术的患儿20例，性别不限，年龄1~24月，体重3~12kg，美国麻醉医师协会（American society of anesthesiologists，ASA）分级Ⅲ或Ⅳ级，术中拟使用选择性顺行性脑灌注（selective antegrade cerebral perfusion，SACP）。采用随机数字表法，将20例患儿随机分为2组（n=10）：乌司他丁组（U组）和对照组（C组）。U组给予乌司他丁2万U/kg，用生理盐水将乌司他丁稀释至1万U/ml，麻醉诱导后经颈内静脉注射1/3量，CPB开始时和主动脉开放前约5min各使用1/3量；C组在相同时间点给予等容积的生理盐水。分别于麻醉诱导后（T1）、主动脉阻断后10min（T2）、主动脉开放后10min（T3）、CPB结束（T4）、CPB结束后6h（T5）、CPB结束后24h（T6）时采集桡动脉血3.5ml，酶联免疫吸附测定（enzyme-linked immunosorbent assay，ELISA）法测定血浆S100B蛋白（S100B protein，S100B）和神经元特异性烯醇化酶（neuronspecific enolase，NSE）浓度。 结果两组T1时血浆S100B及NSE浓度无统计学差异（P＞0.05）；与T1时比较，两组血浆S100B及NSE浓度在T2~5时均升高（P＜0.05），T6时差异无统计学意义（P＞0.05）；与C组比较，U组T2~5时血浆S100B及NSE浓度降低（P＜0.05）。 结论乌司他丁可减轻CPB下主动脉弓手术患儿的脑损伤。
[Abstract]:Part I comparison of the effect of SACP and DHCA in pediatric aortic arch surgery Objective to compare selective antegrade cerebral perfusion with selective antegrade cerebralperfusion. Deep hypothermic circulatory arrest. The effect of DHCA in the operation of aortic arch in children. Methods 53 cases of cardiopulmonary bypass were collected from January 2008 to July 2011 in our hospital. The aortic coarctation of coarctation of CoA) or interrupted aortic arch aortic arch were observed. CPB time, aortic occlusion time and SACP time, operation time, minimum nasopharyngeal temperature were calculated. Minimum rectal temperature and other CPB bypass, postoperative 24 h urine volume, postoperative 24 h chest drainage flow, positive muscle strength drug score, waking time, mechanical ventilation time, ICU stay time, death. Complications of nervous system and acute renal failure. According to the method of cerebral protection, 53 cases were divided into DHCA group (n = 23) and SACP group (n = 30). To compare the condition of cardiopulmonary bypass (CPB) and postoperative recovery. Results compared with the DHCA group, the lowest nasopharyngeal temperature and minimum rectal temperature in the DHCA group increased significantly (P 0.05), the thoracic drainage volume 24 hours after operation, and the postoperative mechanical ventilation time. Postoperative ICU residence time significantly decreased P0.050.Mortality and neurological complications were observed in both groups. There was no significant difference in the incidence of acute renal failure and low cardiac output syndrome (P 0.05). Conclusion the cerebral protective effects of SACP and DHCA in pediatric aortic arch surgery are similar. SACP is beneficial to the recovery of respiratory function and the reduction of postoperative bleeding and ICU residence time. Effect of ulinastatin on brain injury in children undergoing aortic arch surgery under cardiopulmonary bypass Objective to evaluate the effect of ulinastatin on brain injury in children undergoing aortic arch operation under cardiopulmonary bypass (CPB). Methods coarctation of aorta was performed on CPB. Coa) or aortic arch interrupted aortic archIA) combined with intracardiac malformation correction in 20 cases, sex was not limited, age ranged from 1 to 24 months. The body weight was 312kg, and American society of anestheologists (ASA) was graded 鈪

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