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目的:探讨婴幼儿体外循环术后肺损害机理及平衡超滤联合改良超滤对其肺功能保护效果。方法:将60例先天性心脏病患儿随机分为对照组(C)、改良超滤组(M)和平衡超滤联合改良超滤组(U)。M组在转流结束后应用改良超滤,U组在转流开始后进行平衡超滤,转流结束后进行改良超滤。分别在转流前(T1)、转流结束后20min(T2)、术后2h(T3)、术后6h(T4)、术后12h(T5)和术后24h(T6)测定记录气道峰压(Ppeak)、呼吸停顿压(Ppause)、潮气量(TV)、呼吸频率(F)、吸入氧浓度(FiO2)和吸气比例(insp%)并测量动脉血中丙二醛(MDA)、血栓素花生四烯酸(TXA2)、白三烯(LT)的浓度。结果:各组体外循环术后较术前的肺静态顺应性(Cstat)、氧合指数(OI)降低,肺泡-动脉氧分压(AaDO2)增加,在T3、T4时间U和M组的Cstat、OI高于C组;AaDO2低于C组。C组MDA、TXA2、LT术后浓度均较术前升高,在T3、T4、T5时间高于U和M组。结论:术后肺功能损害可能与CPB后花生四烯酸代谢产物之间浓度失衡导致肺毛细血管内皮损伤有关。联合应用平衡超滤和改良超滤可降低血浆中MDA、TXA2、LT的浓度,调节花生四烯酸各代谢产物之间浓度失衡,减轻炎性反应,改善患儿肺脏的通气功能和换气功能,具有良好肺保护作用。
Objective: To investigate the mechanism of lung injury after cardiopulmonary bypass in infants and young children with balanced ultrafiltration combined with modified ultrafiltration on pulmonary function protection. Methods: Sixty children with congenital heart disease were randomly divided into control group (C), modified ultrafiltration group (M) and balanced ultrafiltration plus modified ultrafiltration group (U). In group M, modified ultrafiltration was applied after the end of the commutation, group U was subjected to balanced ultrafiltration after the start of the commutation, and modified ultrafiltration was performed after the end of the commutation. Airway peak was recorded before T 1, T 2, T 2, T 6, T 6 and T 6 respectively Ppeak, Ppause, tidal volume (TV), respiratory rate (F), FiO2, and insp% were measured and arterial blood malondialdehyde (MDA) Thromboxane, arachidonic acid (TXA2), leukotriene (LT) concentrations. Results: The Cstat, OI and AaDO2 increased after CPB in each group, and Cstat in U and M groups at T3 and T4 , OI higher than C group; AaDO2 lower than C group. The concentrations of MDA, TXA2 and LT in group C were higher than those before operation and higher than those in group U and M at T3, T4 and T5. Conclusion: Postoperative pulmonary dysfunction may be related to the imbalance of arachidonic acid metabolites after CPB leading to pulmonary capillary endothelial injury. Combined application of balanced ultrafiltration and modified ultrafiltration can reduce plasma concentrations of MDA, TXA2 and LT, regulate the concentration imbalance among arachidonic acid metabolites, reduce the inflammatory reaction, and improve the ventilation and ventilation of children’s lungs , With good lung protection.