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目的观察乌司他丁对重度紫绀型先天性心脏病患儿的心肺保护作用。方法将2010-06/2015-06月于作者科室行根治手术治疗的60例重度紫绀型先天性心脏病患儿随机分为乌司他丁组和对照组,每组30例。乌司他丁组体外循环(cardiopulmonary bypass,CPB)时使用乌司他丁20 000 U/kg,术后3 d每日使用乌司他丁20 000 U/kg。对照组同期使用生理盐水。比较两组患儿临床指标:手术时长、CPB时间、心脏停跳时间、手术结束时动脉血压和中心静脉压、监护室治疗时间、术后住院时长、血管活性药物使用情况,术后血气分析指标:动脉血氧分压(arterial partial pressure of oxygen,Pa O2)和二氧化碳分压(partial pressure of carbon dioxide,Pa CO2),气道压力峰值(airway pressure peak,Ppeak)以及术后机械通气时长和肺部感染例数。结果两组手术效果尚满意,乌司他丁组患儿死亡1例(总死亡率1.6%),两组患儿手术时长、CPB时间、心脏停跳时间和术中心脏复跳情况及术后住院时长无统计学差异。与对照组比较,乌司他丁组患儿CPB超滤后动脉血压高、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(P均<0.05)。两组患儿术后动脉血血气分析PCO2无明显差异。乌司他丁组患儿Pa O2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重度紫绀型先天性心脏病患儿围手术期治疗,对患儿心肺功能具有保护作用。
Objective To observe the cardiopulmonary protective effect of ulinastatin in children with severe cyanotic congenital heart disease. Methods Sixty children with severe cyanotic congenital heart disease undergoing radical surgery from 2010-06 / 2015-06 were randomly divided into ulinastatin group and control group, with 30 cases in each group. The ulinastatin group received ulinastatin 20 000 U / kg for cardiopulmonary bypass (CPB) and 20 000 U / kg for ulinastatin for 3 days after operation. Control group with saline over the same period. The clinical parameters of the two groups were compared: duration of operation, CPB time, cardiac arrest time, arterial blood pressure and central venous pressure at the end of surgery, treatment time in the care room, length of postoperative hospital stay, vasoactive drug use, postoperative blood gas analysis index : Arterial partial pressure of oxygen (Pa O2) and partial pressure of carbon dioxide (Pa CO2), airway pressure peak (Ppeak) and postoperative duration of mechanical ventilation and lung Department of infection cases. Results The results of the two groups were satisfactory. One patient died of ulinastatin (total mortality 1.6%). The duration of operation, CPB time, cardiac arrest time and cardiac resuscitation in the two groups were significantly higher than those in the control group There was no significant difference in hospitalization duration. Compared with the control group, CPB ultrafiltration in patients with ulinastatin showed high arterial pressure, low central venous pressure, less postoperative vasoactive drug use and shorter duration of intensive care unit treatment (all P <0.05). Two groups of children with arterial blood gas analysis PCO2 no significant difference. The ulinastatin group had higher Pa O2, lower Ppeak, shorter duration of mechanical ventilation and fewer cases of pulmonary infection. Conclusion Ulinastatin can be safely used in the perioperative treatment of children with severe cyanotic congenital heart disease and has a protective effect on the cardiopulmonary function.