脂微球化前列地尔对体外循环诱发小儿肺损伤的影响

目的 评价脂微球化前列地尔对体外循环(CPB)诱发小儿肺损伤的影响.方法 择期CPB下行先天性心脏病矫正术患儿27例,年龄100 d～9岁,体重5～22 kg,心功能Ⅰ或Ⅱ级,随机分为2组:对照组(C组,n=12)和脂微球化前列地尔组(P组,n=15).P组预充液中加入脂微球化前列地尔10 ng/ml,麻醉诱导后即刻经中心静脉输注脂微球化前列地尔10 ng·kg-1·min-1至术毕,C组给予等容量生理盐水.于CPB开始前即刻(T1)、主动脉开放后30 min(T2)、2 h(T3)、6 h(T4)及24 h(T5)时取桡动脉血样,行动脉血气分析及中性粒细胞(PMN)计数,采用酶联免疫吸附法测定血浆白细胞介素6(IL-6)、IL-8、IL-10、肿瘤坏死因子α(TNF-α)和基质金属蛋白酶-9(MMP-9)的浓度;计算动态肺顺应性(Cd)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)及呼吸指数(RI).结果 与C组比较,P组OI升高,RI、A-aDO2、血浆IL-6、IL-8、TNF-α、IL-10、MMP-9浓度及PMN计数降低(P<0.05或0.01).结论 脂微球化前列地尔可减轻CPB诱发的小儿肺损伤,可能与其减轻肺组织炎性反应有关.

Effects of lipo-alprostadil on lung injury induced by cardiopulmonary bypass in children

Objective To investigate the effects of lipo-alprostadil on lung injury induced by cardiopulmonary bypass (CPB) in children. Methods Twenty-seven ASA Ⅰ or Ⅱ children aged 100 d-9 yr weighing 5-22 kg undergoing elective cardiac surgery under CPB were randomly divided into 2 groups: control group (C, n=12) and lipo-alprostadil group (P, n=15). In group P lipo-alprostadil 10 ng/ml was added to the priming solution and infused via CVP line at 10 ng·kg-1·min-1 immediately after induction of anesthesia until the end of operation. Group C received equal volume of normal saline instead of lipo-alprostadil. Blood samples were obtained from radial artery immediately before CPB (T1), at 30 min (T2), 2 h (T3), 6 h (T4) and 24 h (T5) after aortic unclamping for blood gas analysis, PMN count and determination of plasma IL-6, IL-8, IL-10, TNF-α and MMP-9 concentrations (by ELISA). Alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (OI), dynamic lung compliance (Cd) and respiratory index (RI) were calculated. Results OI was significantly higher while RI, A-aDO2, the plasma concentrations of IL-6, IL-8, TNF-α, IL-10, MMP-9 and PMN count were lower in group P than in group C. Conclusion Lipo-alprostadil can ameliorate lung injury induced by CPB in children by reducing inflammatory response of the lung tissue.