乌司他丁对复杂先天性心脏病患儿体外循环围术期肺保护作用的研究

发布时间：2018-08-11 18:44

【摘要】：目的观察乌司他丁对复杂紫绀型先天性心脏病小儿体外循环围术期肺功能的保护作用。方法采用前瞻性随机对照研究方法,对行心脏畸形根治手术的复杂紫绀型先天性心脏病66例患儿,年龄60 d~4岁,随机分配于乌司他丁组和对照组。两组给药方案:乌司他丁组,注射用乌司他丁30 000 U/kg加入体外循环预充液,术后4 h静脉注射乌司他丁10 000 U/kg;对照组,给予等量生理盐水。采集并对比两组术前(T0)、术后即时(T1)和术后12 h(T2)呼吸功能参数、动脉血气指标和炎症因子浓度。结果乌司他丁组入选32例,对照组30例。乌司他丁组T1时点动脉血氧分压(Pa O2)(305.80±77.49 vs 250.43±61.21)、氧合指数(OI)(432.77±118.40 vs 342.33±84.10)、肺泡-动脉血氧分压差[P(A-a)O2](154.67±89.69 vs 220.13±66.04)、吸气平台压(Pplat)(24.17±3.91 vs 27.13±5.02)、肺静态顺应性(Cst)(5.91±1.94 vs 4.83±1.53)均优于对照组(P0.05),血清肿瘤坏死因子[(117.26±66.05)pg/m L vs(168.05±104.05)pg/m L]、白细胞介素-6[(129.74±88.97)pg/m L vs(185.61±107.49)pg/m L]浓度低于对照组(P0.05);T2时点OI(372.24±122.35 vs 308.78±105.29)、Cst(6.68±2.63 vs 5.63±1.86),乌司他丁组优于对照组(P0.05);两组机械通气延长率比较,乌司他丁组显著低于对照组(16.13%vs 43.33%,P0.05)。结论围术期应用乌司他丁对复杂紫绀型先天性心脏病小儿肺功能有保护作用。
[Abstract]:Objective To observe the protective effect of ulinastatin on pulmonary function during cardiopulmonary bypass in children with complex cyanotic congenital heart disease.Methods 66 children with complex cyanotic congenital heart disease, aged 60 days to 4 years, were randomly divided into Ulinastatin group and control group. Ulinastatin group: Ulinastatin 30 000 U/kg for injection was added into cardiopulmonary bypass precharge solution, Ulinastatin 10 000 U/kg was intravenously injected 4 hours after operation, and normal saline was given to the control group. Respiratory function parameters, arterial blood gas index and inflammatory factor concentration were collected and compared between the two groups before operation (T0), immediately after operation (T1) and 12 hours after operation (T2). Ulinastatin group was enrolled in 32 cases and control group in 30 cases. Ulinastatin group had arterial oxygen partial pressure (PaO 2) (305.80 77.49 vs 250.43 Pulmonary static compliance (Cst) (5.91 [(5.91 +1.94 vs 4.94 vs 4.94 vs 4.83 [(P 0.05), (5.91 [(5.91 [(1.94 vs 1.94 vs 4.83 vs 4.83 [(P 0.05)], serlevels of TN [(117.26 [(66.05 [(117.26 [66.05) pg / m L vs (168.05 [(168.05 [104.05 [104.05) pg / ml], interleuk-6 [(129.74 [(129.74 [88.74 [88.97) 97) pg / ml vs (185.61 [107.49) pg / ml] were significantly lower than those 2. Ulinastatin group was superior to the control group (P 0.05), and the prolongation rate of mechanical ventilation in the two groups was significantly lower than that in the control group (16.13% vs 43.33%, P 0.05). Conclusion Ulinastatin has protective effect on lung function in children with complex cyanotic congenital heart disease during perioperative period.
【作者单位】：第二军医大学;广州军区广州总医院心血管外科;
【基金】：广东省科技计划项目(编号:2014A02021226318) 广东省医学科学技术研究基金(编号:A2014486)
【分类号】：R726.5

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