大剂量沐舒坦对婴儿体外循环围术期肺保护作用研究

摘要

目的 探讨大剂量沐舒坦对婴儿体外循环(ECC)围术期的肺保护作用.方法 对2009年3月至2010年6月期间行心脏手术符合研究条件的婴儿采用随机、双盲原则进行分组.组Ⅰ为对照组,50例,平均年龄(5.23±0.33)个月,平均体重(5.38±0.62) kg,ECC 围术期不给予任何呼吸系统用药,术后常规呼吸机辅助;组Ⅱ为实验组,50例,平均年龄(5.51±0.43)个月,平均体重(5.26±0.22)kg,术前口服沐舒坦口服液[(15 mg/(kg·d),连用3 d],术中及术后给予沐舒坦注射液[(15 mg/(kg·d),连用5d ]微量泵持续泵人,术后并给予多索茶碱注射液[(15 mg/(kg·d),连用5 d]静脉注射及异丙托溴胺溶液200 μg,气道吸入,4次/d,连用5 d.手术、麻醉、灌注、监护人员固定.检测指标:① 呼吸力学指标:肺静态顺应性(Cstat)、平台压(Plat)、气道阻力(R); ②肺表面活性物质(PS)相关蛋白:SP- B; ③ 细胞因子:肿瘤坏死因子(TNF)-α、白介素-1(IL-1)等变化.检测时间点:①麻醉诱导后采基础值,② ECC后1 h,③术后24 h,④术后48 h.同时对比两组机械通气时间、ICU时间及住院天数指标上的差异.结果 两组婴儿术前一般资料、ECC时间及阻闭时间无差异.但两组婴儿呼吸力学指标在ECC结束即出现明显改变,且以对照组变化更为显著,主要表现为与基础值对比Cstat下降(P<0.05),对照组Cstat术后1 h达最低点; 两组PaO2 及PaO2/FiO2在ECC结束时显著下降(P<0.01),而实验组术后PaO2/FiO2均高于相应时间点的对照组值(P<0.05);两组婴儿围术期TNF-α 、IL-1无显著变化,但对照组术后的SP-B较基础值显著下降(P<0.05);两组住院时间无显著差异,但实验组婴儿机械通气时间及ICU时间明显短于对照组(P<0.05).结论 大剂量沐舒坦对ECC围术期婴儿呼吸功能有一定保护作用.%OBJECTIVE To explore the effect of high - dose mucosolvin on infant lungs following extracorporeal circulation ( ECC ). METHODS Infants underwent cardiosurgery during March 2009 to June 2010 corresponding with the research condition were randomly divided into two groups: group 1 and group 2 ( 50 cases in each group ). The mean age and mean weight were ( 5. 23 ±0. 33 ) months and ( 5. 38 ±0. 62 ) kg in group 1 , and ( 5. 51 ±0. 43 ) months and ( 5. 26 ±0. 22 ) kg in group 2 respectively. In group 1, patients did not receive any respiratory drug perioperatively and underwent conventional mechanical ventilation postoperatively. In group 2, mucosolvin ( 15 mg/( kg · d ) ) was administered perioperatively, and doxofylline ( 15 mg/( kg · d ), 5d ) and pratropium bromide solution ( 200μg, 5d ) were administrated postoperatively. Fix the same surgeon, anesthetist, perfusionist, custodial care and the nurse. Mechanical ventilation parameters, pulmonary surfactant - related protein ( SP - B ) and cytokines were evaluated after induction of anesthesia,and 30 minutes, 24 hours and 48 hours after ECC. The differences of mechanical ventilation time, intensive care unit time and hospitalization time between two groups were also compared. RESULTS At the end of ECC, all PaO2/FiO2 values in group 2 were higher than those in group 1( P ＜ 0. 01 ). Postoperative SP - B levels in group 1 decreased significantly compared to the baseline value ( P ＜ 0. 05 ). There was no significant difference in hospitalization time between both groups, but both mechanical ventilation time and intensive care unit time of infants in group 2 were significantly shorter than those in group 1 ( P ＜0. 05 ). CONCLUSION These findings indicate that high - dose mucosolvin possesses certain protective effects on respiratory functions in infant underwent heart operations with ECC.