乌司他丁对法洛四联症根治术婴幼儿的心肺保护作用

目的观察乌司他丁对法洛四联症根治手术婴幼儿的心肺保护作用。方法 2011年6月至2012年3月于我中心行根治手术的连续40例法洛四联症婴幼儿随机分为乌司他丁组和对照组,每组20例。乌司他丁组体外循环预充乌司他丁10 000 U/kg,术后三天内每日给予乌司他丁10 000U/kg。对照组于相应时间点给予等量生理盐水。比较两组患儿手术时间、体外循环时间、心脏停搏时间、监护室治疗时间、术后住院时间、手术结束时动脉血压和中心静脉压、血管活性药物使用情况,入监护室时动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)、气道压力峰值(Ppeak)以及术后机械通气时间和肺部感染发生例数。结果两组患儿均无住院死亡,手术时间、体外循环时间、心脏停搏时间和术中主动脉开放后心脏复跳情况及术后住院时间无差异(P>0.05)。与对照组比较,乌司他丁组患儿超滤完成后动脉血压高、中心静脉压低,术后血管活性药物使用较少,监护室治疗时间短(均P<0.05)。两组患儿入监护室即时PaCO2无明显差异(P>0.05)。与对照组比较,乌司他丁组患儿PaO2较高,Ppeak较低,术后机械通气时间较短,肺部感染发生例数少。结论乌司他丁能够安全用于法洛四联症根治手术婴幼儿围术期治疗,对患儿心肺功能具有保护作用。

Cardiopulmonary protective effects of ulinastatin in infants with tetralogy of Fal- lot underwent radical surgery

Objective To investigate cardiopulmonary protective effects of ulinastatin in infants with tetralogy of Fallot （TOF） underwent radical surgery under cardiopulmonary bypass. Methods From June 2011 through March 2012, 40 successive infants with TOF scheduled for radical surgery were randomly grouped as ulinastatin group （UTI group, 20 eases） and control group （CTL group, 20 eases）. UTI patients received 10 000 U/kg of ulinastatin in prime solution for cardiopulmonary bypass, and the same dose of ulinas- tatin per day for 3 days after surgery. CTL infants received equal volume of saline at the same time points. The peri - operative parame- ters, such as operating time, eardiopulmonary bypass time, cardiac arrest time, ICU time, post - operative length of stay, mean arteri- al pressure （MAP） and central venous pressure （CVP） immediately after modified ultrafiltration, post -operative inotropic scores, PaO2, PaCO2 and peak pressure of airway （Ppeak） upon ICU arrival, ventilation time and post- operative pulmonary infections were recorded. Results There was no hospital death in either group. There was no statistical difference between the two groups as to oper- ating time, cardiopulmonary bypass time, cardiac arrest time, ICU time and the ratio of spontaneous rhythm recovery after aortic cross- clamp removal. Compared with CTL group, patients in UTI group had higher MAP, lower CVP right separation from modified ultrafil- tration, and shorter post - operative length of stay. The post - operative inotropic scores in UTI group were significantly reduced com- pared with CTL patients （ P 〈 0.05）. There was no statistical difference between the two groups in the values of PaCO2. UTI patients had higher value of PaO2, lower Ppeak in the same ventilation condition upon ICU admission. There were significantly less pulmonary infections in UTI patients （2/20） compared with CTL patients （8/20）. Conclusion Peri - operative application of ulinastatin in in- fants with TOF underwent radical surgery under cardiopulmonary bypass is safe and has potential cardiopulmonary protective effects.