经肺动脉持续灌注低温含氧血及乌司他丁对肺的保护作用

目的:观察持续肺动脉灌注低温含氧血混和乌司他丁对肺功能的保护作用。方法:130例瓣膜病患者随机分为肺保护组70例,对照组60例。肺保护组在升主动脉阻断后,经主肺动脉持续灌注低温含氧血混和乌司他丁。对照组常规进行瓣膜置换手术。分别在麻醉诱导期、转流结束即刻、转流结束后6、12、24h取桡动脉血,应用放射免疫法测定肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)水平;同时记录机械辅助通气时间。结果:两组患者体外循环后上述参数水平开始升高,24h仍高于术前(P<0.01),但肺保护组TNF-α、IL-6、IL-8水平上升幅度在各时间点均低于对照组(P<0.05或P<0.01)。肺保护组机械辅助通气时间显著低于对照组(P<0.01)。结论:持续肺动脉灌注低温含氧血混和乌司他丁能够减轻体外循环术后肺损伤。

Direct perfusion with hypothermic oxygenated blood mixed with ulinastatin through pulmonary artery to protect pulmonary function during cardiopulmonary bypass

Objective To observe the influence of continuous perfusion of pulmonary artery with hypothermic oxygenated blood mixed with ulinastatin on the pulmonary function.Methods One hundred and thirty patients with heart valves disease were divided into 2 groups:protective group and control group.In control group,the operation was performed in a routine way,while in protective group,pulmonary artery was infused with hypothermic oxygenated blood mixed with ulinastatin.The tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)were assessed at different time points:anesthetic induction,the end of CPB,6 h after CPB,12 hr after CPB,and 24 hr after CPB.The time of mechanical ventilation was obtained as well.Results In both groups,compared with the baseline values,plasma levels of TNF-α、IL-6、IL-8 were gradually increased after the beginning of CPB and still maintained a high level at 24 hours after CPB(P < 0.05).Comparing to the control group,the increasing degree of TNF-α、IL-6、IL-8 were significantly lower than that in protective group(P<0.01).Conclusion Continuous perfusion of pulmonary artery with hypothermic oxygenated blood mixed with ulinastatin can alleviate the lung injury after CPB.