肺动脉灌注在微创心内直视术中的肺保护

目的：探讨低温保护液肺动脉灌注对右腋下小切口心内直视术的肺保护作用。方法：40例患者分为对照组（常规手术组）和实验组（肺灌注组）,每组各20例,均为室间隔缺损,无合并肺动脉高压及其他心内畸形。对照组采用右腋下直切口开胸,常规建立体外循环（CPB）进行心内直视手术。实验组患者体位、切口选择、建立CPB同对照组,阻断升主动脉后同时经肺动脉灌注低温保护液。分别在不同时点检测动脉血中性粒细胞计数及抗肿瘤坏死因子-α（TNF-α）、KC含量,超氧化物歧化酶（SOD）活性,计算氧合指数（OI）,监测气道峰压,同时获取少许肺组织进行病理形态学检测。结果：两组患者年龄、体重、CPB时间、主动脉阻断时间差异无显著性,两组患者均无死亡,无低心排综合征,无呼吸功能不全等并发症。两组比较：主动脉阻断后不同时点、OI增高（P〈0.05）,气道峰压降低（P〈0.05）,与对照组比较主动脉阻断后不同时点、血清TNF-α、KC水平明显降低（P〈0.05）,与对照组比较主动脉阻断后不同时点、SOD活性水平明显升高（P〈0.05）,与对照组比较主动脉开放后不同时点中性粒细胞计数明显降低（P〈0.05）。结论：低温保护液肺动脉灌注可以减轻右腋下小切口心内直视术的全身炎性反应,改善肺功能。

Protective effect of pulmonary artery perfusion with hypothermia perfusate on lung during intracardiac operation by right subaxillary small incision

Objective：To investigate the protective effect of pulmonary artery perfusion with hypothermia perfusate on lung during intracardiac operation by right subaxillary small incision.Methods：Fourty cases with ventricular septal defect,not with pulmonary hypertension and other cardiac malformations were randomly divided into 2 groups with 20 cases each group：control group,experimental group.Cases of control group received intracardiac operation by right subaxillary incision.The posture of the patient,the incision and the extracorporeal circulation used in the 2 groups were similar.The experimental group received pulmonary artery perfusion with hypothermia perfusate after ascending aorta blocked.The plasm level of TNF-α,KC and the activity of SOD in arterial blood were analysed at different time.Consequently,OI,peak and neutrophils counting were determined at different time.Some lung tissue was taken for histologic analysis.Results：There were no significance in distinctions of the age,weight,the time of extracorporeal circulation and the ascending aorta block in 2 groups.There were also no death,low cardiac output syndrome,respiratory insufficiency or other complications.Compared with the control group after ascending aorta blocked,OI was increased（P〈0.05）,peak was decreased（P〈0.05）,and the plasm level of TNF-α,KC,the neutrophils counting were all decreased obviously（P〈0.05）at different time in the experimental group.the activity of SOD were increased obviously（P〈0.05）at different time in the experimental group.Conclusion：Pulmonary artery perfusion with hypothermia perfusate can ease systemic inflammatory response syndrome of the intracardiac operation by right subaxillary small incision and improve pulmonary function.