去白细胞血预充对婴儿体外循环肺保护作用的研究

目的体外循环（CPB）前去除预充血液中的异体自细胞，探讨其对婴儿CPB肺保护作用。方法60例≤1岁的室间隔缺损患儿随机分成实验组和对照组，实验组用去白细胞血预充，对照组用库存全血预充。测定围术期血浆中性粒细胞弹性蛋白酶（NE）、肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8含量；氧合指数（OI）、肺泡-动脉血氧分压差（P（A-a）O2）和呼吸指数（RI）及术后呼吸机通气时间。结果实验组术后机械通气时间，CPB后血浆NE、TNF-α、IL-6和IL-8浓度，P（A-a）O2和RI低于对照组（P〈0．05，P〈0．01），OI在CPB后高于对照组（P〈0．05）。结论去白细胞血预充能减少婴儿CPBNE、TNF-α、IL-6和IL-8的含量，改善术后肺换气功能，缩短术后的机械通气时间，具有良好的肺保护作用。

Lung Protective Effection of Leukocyte-depleted Priming Fluid on Cardiopulmonary Bypass in Infants

OBJECTIVE To evaluate the lung protective effect of infants by the removal of allogeneic leukocytes in priming fluid on cardiopulmonary bypass （CPB） in infants. METHODS Total 60 patients under 1 year - old with ventricular septal defect （VSD） repair undergoing CPB were randomly divided into experimental group and control group. The experimental group used leukocyte -removed priming fluid, and the control group used packed whole blood priming solution. The plasma levels of neutrophil elastase （NE） , tumor necrosis factor - α （ TNF - α） , interleukin - 6 （ IL - 6 ） , interleukin - 8 （ IL - 8 ） , oxygen index （ OI ） , alveolar - arterial oxygen difference （ P（A - a） O2 ） , respiratory index （ RI ） of perioperation and mechanical ventilation supporting time postoperation were measured. RESULTS Post - operative mechanical ventilation supporting time, the level of NE, TNF - α, IL - 6, IL - 8, P（A-a） O2, RI were lower in experimental group than those in control group （ P 〈0.05, P 〈0.01） ; and OI was higher in experimental group （ P 〈0.05）. CONCLUSION Using leukocyte -removed priming fluid could reduce the releasel of NE ,TNF-α, IL -6 and IL- 8, improve pulmonary oxygenation function, and is helpful for post - opertive lung protection in infants.