乌司他丁对室间隔缺损修补术婴儿体外循环后炎性因子及肺功能的影响

发布时间：2018-04-02 21:17

  本文选题：婴儿　切入点：乌司他丁　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:体外循环(cardiopulmonary bybass CPB)是进行心脏直视手术中的一项重要的辅助技术。体外循环的临床使用已经有60余年的历史,它在器材设备、理论水平及临床应用都发生了很大变化。现阶段对于体外循环的研究非常多,但是CPB术后并发症尤其是肺损伤依然存在。乌司他丁(Ulinastatin UTI)是蛋白酶抑制剂的一种,国内外研究表明它可以抑制炎症,保护肺功能。对于乌司他丁应用于CPB的研究也非常广泛,但是对于婴幼儿的报道并不多。本课题的目的在于研究乌司他丁(UTI)在婴幼儿先天性心脏病心内直视手术中的作用。通过对不同时间点的中性粒细胞弹性蛋白酶(NE)、炎性介质(TNF-α,IL-6)血浆浓度的测定以及监测呼吸指数(RI)和氧合指数(OI)来研究对于婴儿乌司他丁在体外循环中的肺保护作用。方法:选择在体外循环辅助下行室间隔缺损修补术的患儿50例(男24例,女26例),随机分为两组,试验组(U组)和对照组(C组),每组均为25例,ASA分级均为Ⅱ级,年龄在2个月~6个月,体重在3kg~6kg。两组患儿均采用相同的麻醉方法、体外方法和手术步骤。试验组(U组)的乌司他丁的用量为2万U/kg,用生理盐水将其稀释至10毫升,5毫升与主动脉插管前由中心静脉缓慢推入,另外5毫升直接加入到体外循环的预冲液中,随机转入体内。对照组(C组)用生理盐水来代替,方法同上。分别于手术切皮前(T0),腔静脉开放时(T1),CPB结束4小时(T2),CPB结束24小时(T3)取颈内静脉血4毫升,利用酶联免疫法(Elisa)来测量NE,TNF-α以及IL-6的浓度。呼吸功能监测:分别于T0~T3这四个时间点取桡动脉血1毫升行血气分析,记录PaO2,PaCO2和红细胞压积(Hct),记录相对应时间点呼吸机的吸入氧浓度(FiO2),利用公式计算出呼吸指数(RI)与氧合指数(OI)。结果:在T0时,两组患儿的NE,TNF-α,IL-6的水平以及RI,OI的数值差别无统计学意义(P0.05),与T0相比较,在T1~T3时两组患儿的血清NE,TNF-α,IL-6的水平上升(P0.05),两组患儿的RI值增大(P0.05)、OI值减小(P0.05)。与C组相比较,U组患儿在T1~T3时的血清NE,TNF-α,IL-6的水平下降(P0.05),RI值减小(P0.05)、OI值增大(P0.05)。结论:1体外循环(CPB)可以促进机体释放炎性介质和NE,造成肺功能的损伤。2乌司他丁可以抑制婴儿CPB后炎性介质以及NE的释放而保护肺功能。
[Abstract]:Objective: cardiopulmonary bybass (CPB) is an important assistant technique in open heart surgery.Cardiopulmonary bypass (CPB) has been used in clinic for more than 60 years. It has changed greatly in equipment, theory and clinical application.There are many studies on cardiopulmonary bypass at present, but complications, especially lung injury, still exist after CPB.Ulinastatin UTI is a protease inhibitor, which can inhibit inflammation and protect lung function.Studies on the use of ulinastatin in CPB are also extensive, but there are few reports of infants and young children.The purpose of this study was to study the role of ulinastatin (UTI) in open heart surgery in infants with congenital heart disease.The pulmonary protective effect of ulinastatin on infants during cardiopulmonary bypass (CPB) was studied by measuring the plasma concentrations of neutrophil elastase, TNF- 伪 and IL-6, and monitoring respiratory index (RI) and oxygenation index (OII) at different time points.Methods: fifty children (24 males and 26 females) with ventricular septal defect repair assisted by cardiopulmonary bypass were randomly divided into two groups: experimental group (group U) and control group (group C).The age ranged from 2 months to 6 months and the body weight was 3 kg to 6 kg.The two groups were treated with the same anesthetic method, extracorporeal method and surgical procedure.The dosage of ulinastatin was 20 000 U / kg, diluted with normal saline to 10 ml / 5 ml and slowly pushed through the central vein before aortic catheterization, and the other 5 ml was added directly to the cardiopulmonary bypass (CPB) preflushing solution.Into the body at random.The control group (group C) was replaced by normal saline.The concentration of NETNF- 伪 and IL-6 were measured by enzyme-linked immunosorbent assay (Elisa).Respiratory function monitoring: 1 ml of radial artery blood was taken at the four time points of T0~T3 for blood gas analysis. PaO2 and HCT were recorded. The inhaled oxygen concentration of ventilator was recorded at the corresponding time point. The respiratory index (RI) and oxygenation index (Oi) were calculated by using the formula.缁撴灉:鍦═0鏃，

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