灯盏花素对CPB下心内直视手术患儿肺损伤的影响

目的 探讨灯盏花素对CPB下心内直视手术患儿肺损伤的影响.方法 浅低温CPB下行房间隔、室间隔缺损修补术的患儿45例,年龄3 ～ 65个月,体重5～21 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患儿随机分成3组(n=15):对照组(C组)、低剂量灯盏花素组(B1组)和高剂量灯盏花素组(B2组).于麻醉诱导完成后,经30 min静脉输注生理盐水15 ml(C组)或灯盏花素0.5 mg/kg(B1组)、1 mg/kg(B2组).分别于术前(T0)、主动脉开放30 min(T1)、开放1 h(T2)、术后3 h(T3)、6h(T4)时取外周动脉血样,采用ELISA方法测定血浆中性粒细胞弹性蛋白酶(NE)、前降钙素(PCT)的浓度.于To、T3、T4时测定PaO2和PaCO2,计算肺泡-动脉氧分压差(PA-a O2)和氧合指数(OI).结果 三组患儿各时点OI和PA-a O2比较差异无统计学意义(P＞0.05)；与T0时比较,三组T1～4时血浆PCT浓度升高,C组T1～4时、B1组和B2组T1时血浆NE浓度升高(P＜0.O1),B1组和B2组T2～4时血浆NE浓度差异无统计学意义(P＞0.05)；与C组比较,B1组和B2组T1～4时血浆CT和NE浓度降低(P＜0.01)；B1组和B2组血浆PCT和NE浓度比较差异无统计学意义(P＞0.05).结论 灯盏花素(0.5、1mg/kg)可降低CPB下心内直视手术患儿全身炎性反应,减轻肺损伤.

Effect of breviscapine on lung injury in children undergoing open heart surgery with cardiopulmonary bypass

Objective To investigate the effect of breviscapine on lung injury in children undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods Forty-five ASA Ⅱ or Ⅲ children aged 3-65 months weighing 5-21 kg undergoing open heart surgery with CPB were randomly assigned to 3 groups ( n =15 each):control group (group C),low dose breviscapine group (group B1 ) and high dose breviscapine group (group B2).Normal saline 15 ml(group C),breviscapine 0.5 mg/kg (group B1 )or 1.0 mg/kg(group B2 ) were injected iv over 30min after anesthesia induction.Blood samples were taken before operation ( T0 ),at 30 min and 1 h of aortic unclamping (T1,T2 ),at 3 h and 6 h after operation (T3,T4 ) for determination of plasma procalcitonin (PCT)and neutrophil elastase(NE) concentrations.PaO2 and PaCO2 were recorded at T0,T3,T4 for caculation of oxygenation index (OI) and alveolo-arterial oxygen partial pressure difference (PA-a O2 ).Results There were no significant differences in OI and PA-a O2 among the 3 groups( P ＞ 0.05).Plasma concentration of PCT was higher at T1～4in 3 groups,and plasma concentration of NE was higher at T1 in group C than that at T0 ( P ＜ 0.01 ).Plasma concentrations of PCT and NE were lower in groups B1 and B2 than in group C ( P ＜ 0.01).There were no significant differences in plasma concentrations of PCT and NE between groups B1 and B2 ( P ＞ 0.05).Conclusion Breviscapine(0.5,1 mg/kg) can inhibite systemic inflammatory response and attenuate lung injury in children undergoing open heart surgery with CPB.