血液光量子疗法对体外循环急性肺损伤的保护作用

目的 研究血液光量子疗法(ultraviolet blood irradiation and oxygenation,UBIO)对体外循环急性肺损伤的保护作用。方法 20例术前血红蛋白大于160g／L的先天性心脏病患者随机分为两组,每组10例。实验组手术过程中于血液肝素化后体外循环转流前按10~15ml／kg体重放出自体血作充氧紫外线照射(波长在240~300nm之间),体外循环停机后回输入体内。对照组除术中不放自体血作充氧紫外线照射外,其他处理同实验组。术中监测所有患者血清补体(C3、C4)、白细胞计数和多形核白细胞跨肺差值;动态检测血气分析,计算氧指数(PaO2／FiO2),并记录两组患者术后呼吸机应用时间。结果 两组患者转流前、转流10分钟、停机和术毕两组血清补体(C3、C4)、白细胞计数和氧指数组间比较差异无显著意义(P>0.05),但转流开始后均明显低于转流前;升主动脉开放后5分钟、10分钟和15分钟,实验组多形核白细胞跨肺差值明显小于对照组(P<0.01);术后6小时实验组氧指数明显大于对照组(P<0.01),而应用呼吸机的时间则明显少于对照组(P<0.01)。结论 体外循环心脏手术由于补体激活,白细胞的趋化性增强并隔离于肺组织中,从而引起肺损伤。自体UBIO减少血液破坏,提高红细胞携氧能力,使机体术后得到有效氧供,对体外循环术后患者的肺功能有良好的保护作用。

Protective effect of lung on ultraviolet blood Irradiation and oxygenation of congenital heart disease patients undergoing cardiopulmonary bypass

Objective To evaluate the effects of ultraviolet blood irradiation and oxygenation (UBIO) on the protection of lung during cardiopulmonary bypass. Methods 20 cases of congenital heart disease patients with high hemoglobin (>160g/L) were divided into control group(n=10) and test group (n=10). In test group the heparinize blood were drained from venous (10-15ml/kg body weight) before CPB, and dealt with ultraviolet irradiation (wavelength 240-300nm) and oxygenation (FiO2 100%), then reperfused it at the end of surgery. Before CPB, 10 minutes after the beginning of CPB, the end of CPB and the finish of operation, venous blood was tested the complement 3(C3), 4 (C4); leukocyte count, difference of transpulmonary olymorphonuclear leukocyte and oxygen index (PaO2/FiO2) respectively. Results The level of the difference of transpulmonary olymorphonuclear leukocyte in test group were significantly lower than control group on 5min, 10min, 15min after aorta undamped (P<0. 01), the time of using respirator was significantly fewer in test group than in control group (P<0. 01), but oxygen index was higher after 6 hours operation (P<0. 01). Conclusion UBIO has a better advantageous effects on lung protection during CPB to congenital heart disease patients with high hemoglobin.