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

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4h静脉注射乌司他丁10000 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(PaO2)(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(P＜0.05),血清肿瘤坏死因子[(117.26±66.05) pg/mL vs(168.05±104.05) pg/mL]、白细胞介素-6[(129.74±88.97)pg/mL vs (185.61±107.49) pg/mL]浓度低于对照组(P＜0.05);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(P＜0.05);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％,P＜0.05).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.

Protective effects of ulinastatin on perioperative lung function during cyanotic complex congenital heart disease surgery with cardiopulmonary bypass for children

Objective To evaluate the protective effects of ulinastatin on perioperative lung function in cyanotic complex congenital heart disease surgery with cardiopulmonary bypass in children.Methods Sixty-two children aging from 60 days to 4 years with cardiac surgery were randomly divided into ulinastatin group (n =32) and control group (n =30).In ulinastatin group,the participants were given with ulinastatin (30 000 U/kg intra-operatively and 10 000 U/kg for 4 hours after operation),and saline was given as placebo in control group.Respiratory function parameters and serum inflammatory factors were recorded before operation (T0),immediately after operation (T1) and 12 hours after operation (T2).Results At T1,compared.with control group,the arterial partial pressure of oxygen (PaO2),oxygenation index (OI),alveolar-arterial oxygen difference (P(A-a)O2),inspiratory plateau pressure (Pplat) and the static lung compliance (Cst) were significantly superior in the ulinastatin group;with significantly lower serum tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) (P ＜0.05).At T2,the oxygenation index (OI) and the static lung compliance (Cst) were significantly superior in ulinastatin group than control group (P ＜ 0.05).Significantly lower of prolonged mechanical ventilation rate was observed in ulinastatin group (16.13％) than control group (43.33％,P ＜0.05).Conclusion Perioperative application of ulinastatin has protective effects on pulmonary function in complex cyanotic congenital heart disease operation in children.