Objective To investigate eareliopulmonary protective effeets of ulinastatin in infants with te;tralogy of Fallot ( TOF ) underwent radical surgery unele;r eandiopulmonary bypass. Methods From June 2011 through Mareh 2012, 40 sueeessive infante with TOF seheduled for raelical surgery were randomly gronpeel as ulinastatin group ( UTI group, 20 cases ) and control group ( CTL group, 20 eases ). UTI patie;nts reeeiveel 10 000 U/kg of ulinastatin in prime; solution for eanliopiilmonaiy bypass, and the same close of ulinastatin per day for 3 days after snrgery. CTL infants reeeiveel equal volume ef saline at the same time points. The peri- operative; parame-ters, sueh as cperating time, eardiopulmonaiy bypass time, eareliae arrest time, ICU time, post- operative length of stay, mean arterial pressure; ( MAP ) anel eentral venous pressure ( CVP ) immeeliately after moelifieel ultrafiltratietn, post - operative inotropic seores, PaO2 , PaCO2 anel peak prcssure of airway ( Ppcak ) upon ICU arrival, ventilation time anel post - operative pulmonary infcetions were rccorded. Results There was no hospital eleath in either group. There was no statistical diffcrenee between the two groups as to operating time, eareliopidmonaiy bypass time, careliae arrest time, ICU time and the ratio of spetntane;ous rhythm rccovery after aortic eross-clamp remotvai. Compareel with CTL group, patients in UTI group had higher MAP, letwer CVP right separation from moelifieel ultrafil-tration, anel shorte;r post - operative; length etf stay. The post - operative; inotropic seore;s in UTI group were signifieantly roelueed com-pare;el with CTL patients ( P <0. 05 ). There was no statistieai eliffercnee befween 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 infants with TOF underwent radical surgery under cardiopulmonary bypass is safe and has potential cardiopulmonary protective effects.%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.
展开▼
