改良肺动脉灌注在发绀型先天性心脏病体外循环术中的应用

目的研究体外循环中经肺动脉灌注低温组胺酸-酮戊二酸-色氨酸灌注液(HTK)对发绀型先天性心脏病患儿的肺保护作用。方法 30例发绀型先天性心脏病患儿随机分为灌注组和对照组。灌注组体外循环期间肺动脉灌注低温HTK,对照组常规体外循环。围手术期检测血浆肿瘤坏死因子-α(TNF-α)。征得患儿家长同意,取右下肺组织活检,观察病理变化。检测围手术期动脉血气分析及体外循环(CPB)时间、主动脉阻断时间、呼吸机辅助时间、住监护室(ICU)时间、术后住院时间。结果 2组CPB时间、主动脉阻断时间及术后住院时间比较差异均无统计学意义(P>0.05)。灌注组呼吸机辅助时间、住ICU时间均显著低于对照组(P<0.05)。返回ICU后0、12、24和48 h,灌注组氧合指数均明显高于对照组,肺泡-动脉氧分压差明显低于对照组,差异有统计学意义(P<0.05)。体外循环前,灌注组血浆TNF-α与对照组比较差异无统计学意义(P>0.05);返回ICU后0、12、24和48 h灌注组血浆TNF-α与对照组比较明显降低,差异均有统计学意义(P<0.05)。肺组织病理学观察显示,灌注组体外循环术后肺泡轻度水肿,肺泡内炎症细胞浸润减少;对照组体外循环术后肺泡水肿,肺泡内见大量中性粒细胞浸润。结论改良肺动脉灌注低温HTK可以明显减轻发绀型先天性心脏病体外循环术后肺内炎症反应和改善肺功能。

Modified lung perfusion in cardiopulmonary bypass for cyanotic congenital heart disease

Objective To evaluate the effect of modified lung perfusion with hypothermic histidine-ketoglutarate-tryptophan(HTK) solution on lung function during cardiopulmonary bypass(CPB) in children with cyanotic congenital heart disease(CCHD).Methods Thirty children with CCHD were randomly divided into control group and perfusion group,fifteen cases in each group.The operation was performed with routine approach in control group,while the lung perfusion with hypothermic HTK during CPB was used in perfusion group.The level of plasma tumor necrosis factor-α(TNF-α) was measured.Lung biopsy specimens were obtained after operations for study on pathological changes.At the same time,perioperative period arterial blood gas analysis,cardiopulmonary bypass time,aortic clamping time,ventilation time,intensive care unit(ICU) time and postoperative hospital stay were observed.Results There was no significant difference in CPB time,aortic clamping time and postoperative hospital stay between two groups(P>0.05).The ventilation time and ICU time in the perfusion group was significantly lower than that in the control group respectively(P<0.05).At 0,12,24 and 48 hours after hospitalization in ICU,The oxygenation indices in the perfusion group were significantly higher than those in the control group(P<0.05),while the alveolo-arterial oxygen partial pressure difference in the perfusion group was significantly lower than that in the control group(P<0.05).Before CPB,there was no significant difference in the level of TNF-α between the two groups(P>0.05).At 0,12,24 and 48 hours after hospitalization in ICU,the level of TNF-α in the perfusion group was significantly lower than that in the control group(P<0.05).Lung biopsy showed that there were many alveolus with oedema,and many infiltration in alveolus;but the pathological change was significantly improved in the perfusion group.Conclusion Modified lung perfusion with hypothermic HTK solution can effectively reduce the inflammatory response,and improve the pulmonary function after cardiopulmonary bypass in children with cyanotic congenital heart disease.