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目的:评价体外循环(CPB)中肺动脉灌注低温HTK液对法乐氏四联征(TOF)患儿肺的保护作用。方法:选取TOF患儿24例,随机分为肺动脉灌注组(n=12)和对照组(n=12),计算各组氧合指数(OI)和肺泡-动脉氧分压差(AaDO2),硫代巴比妥酸反应法检测丙二醛(MDA)水平,ELISA法检测内皮素1(ET-1)、可溶性细胞间黏附分子-1(sICAM-1)和P-选择素水平。结果:体外循环(CPB)后0、12、24、48 h,灌注组的OI均显著高于对照组(P<0.05,P<0.01),两组间变化的趋势有显著差异(P<0.05,P<0.01);灌注组的AaDO2均显著低于对照组(P<0.05,P<0.01);两组间CPB后MDA、ET-1、sICAM-1和P-选择素的水平变化趋势均有显著差异(P<0.05,P<0.01)。结论:CPB中肺动脉灌注低温HTK液可有效地减轻内皮细胞损伤,提高TOF矫治术后患儿的肺换气功能,改善预后。
PURPOSE: To evaluate the protective effects of pulmonary arterial infusion of hypothermic HTK solution on the lung of children with tetralogy of Fallot (TOF) during cardiopulmonary bypass (CPB). Methods: Twenty-four children with TOF were selected and randomly divided into pulmonary artery perfusion group (n = 12) and control group (n = 12). The oxygenation index (OI) and alveolar-arterial oxygen pressure difference Thiobarbituric acid reaction was used to detect the level of malondialdehyde (MDA). The levels of ET-1, sICAM-1 and P-selectin were detected by ELISA. Results: At 0,12,24,48 h after cardiopulmonary bypass (CPB), the OI in perfusion group was significantly higher than that in control group (P <0.05, P <0.01), and there was significant difference between the two groups (P <0.05 , P <0.01). The AaDO2 of the perfusion group was significantly lower than that of the control group (P <0.05, P <0.01). The changes of MDA, ET-1, sICAM-1 and P- There was significant difference (P <0.05, P <0.01). CONCLUSION: Pulmonary arterial infusion of hypoxic HTK solution in CPB can effectively reduce endothelial cell injury, improve pulmonary ventilation and improve prognosis in children with TOF.