低温肺保护液肺动脉灌注对首次单纯二尖瓣置换病人的肺保护作用

目的 :研究体外循环期间低温保护液肺动脉灌注对单纯二尖瓣置换病人的肺保护作用。方法 :将 2 0例单纯二尖瓣置换病人随机分为对照组和实验组。实验组在主动脉阻断后、主动脉根部灌注心脏停搏液的同时 ,经肺动脉灌注 4℃含抑肽酶、沐舒坦的低温保护液 ,对照组则不灌注肺保护液 ,分别于术前、开放升主动脉后 2 0 min、体外循环结束时采集外周动脉血 ,进行中性粒细胞计数 ,分别于术前、体外循环结束后 0、3、6和 1 2 h检测动脉血氧分压 ( Pa O2 )、吸入氧浓度 ( Fi O2 ) ,计算氧指数 ( Pa O2 /Fi O2 )及肺泡 -动脉氧压力差 ( P〔 A-a〕O2 )。结果 :对照组在升主动脉开放 2 0 min中性粒细胞计数较术前明显降低 ,实验组的中性粒细胞计数在体外循环结束时明显高于术前 ,实验组与对照组的 Pa O2 /Fi O2 在体外循环结束后 6h达到最低点 ,实验组的氧指数在体外循环结束后 1 2 h回升接近术前正常水平 ,而对照组则未回升至术前正常水平。在体外循环结束后 0、3、6和 1 2 h,实验组的 Pa O2 /Fi O2 均明显高于对照组。再灌注 60 min后实验组 P〔 A-a〕O2 明显低于对照组。实验组气道阻力在体外循环后各时间点明显低于对照组。结论 :体外循环后存在肺损伤 ,使用含抑肽酶低温肺动脉灌注液可明显减轻首次单纯二尖瓣置换

The Protective Effect of Pulmonary Artery Perfusion with Hypothermic Protective Solution on Lungs During Cardiopulmonary Bypass

Objective:To determine the effect of pulmonary perfusion with hypothermic protective solution on lung function during cardiopulmonary bypass(CPB). Methods:20 adult patients suffered from primary simple mitral replacement were randomly divided into two groups. During CPB, the study group were perfused with 4℃ protective solution, wheres the placebo was given in whereas control group. Neutrophil counts,PaO 2/FiO 2 ratio and P 〔A a〕 O 2 were measured. Results:In study group, the neutrophil count at the termination of CPB was higher than that of the prebypass value. In contrast, in control group the neutrophil count the 20 min after removal of aortic cross clamp was lower than that of the prebypass value. At each measuring point PaO 2/FiO 2 ratio of the study group was significantly higher than that of the control group ( P <0.05 ). The P 〔A-a〕 O 2 of study group was lower tham that of control gorup at 60 min after reperfusion. At each timepoint after CPB, the air way resistance of study group was lower than that of control group.Conclusion:Pulmonary artery perfusion with the hypothermic protective solution can obviously reduce lung injury after cardiopulmonary bypass.