不同途径中和肝素对先天性心脏病合并肺动脉高压术后肺循环的影响

摘要

Objective To investigate pulmonary circulation effects of protamine different infusion ways on the acyanotic congeni -tal heart disease(CHD) patients with pulmonary arterial hypertension(PAH) after extracorporeal circulation surgery .Methods Se-lect 80 cases of the CHD patients prepared for extracorporeal circulation surgery ,according to the different routes of administration and with or without PAH ,80 patients are divided into 4 groups (n= 20) :A1(non-PAH ,aortic root administration) ,A2(non-PAH , central venous administration) ,B1(PAH ,aortic root administration ) ,B2 (PAH ,central venous administration) .pulmonary artery pressure(PAP) ,pulmonary venous pressure (PVP) ,central venous pressure (CVP) ,peak airway pressure (Ppeak) ,plateau airway pressure(Pmean ) at the time point of preoperative(T0) ,before infusion of protamine (T1) ,1 minute after infusion of protamine (T2) ,3 min (T3) ,5 min (T4) ,10 min (T5) ,15 min (T6) and 25 min (T7) were recorded .The level of venous blood thromboxane B2(TXB2) was detected .Results After infusion protamine ,the PAP ,PVP ,CVP ,Ppeak and Pmean of group A2 and group B2 are higher compared to group A1(P< 0 .05) and group B1(P< 0 .01) respectively ;Compared with preoperation (T0) ,the TXB2 in 4 groups increased obviously after infusion protamine (T2 to T7) (P< 0 .05) ;Compared with group A1 and group B1 ,the TXB2 of group A2 and group B2 increased more significantly (P< 0 .01) .Conclusion Patients with congenital heart disease after intracardi-al surgery with extracorporeal circulation use trace pump infusion protamine through the aortic root ,which have little effect on pul-monary circulation ,can significantly reduced TXB2 release compared with central vein administration ,it can avoid a high concentra-tion of protamine directly into the pulmonary circulation that can strongly stimulate the pulmonary vascular and tracheal smooth muscle .Especially in the CHD patients with PAH .%目的：探讨不同途径输注鱼精蛋白对非紫绀型先天性心脏病合并肺动脉高压患者体外循环术后肺循环的影响。方法选择手术治疗非紫绀型先天性心脏病患者80例，根据不同给药途径（主动脉、中心静脉）及有无肺动脉高压分为4组，每组20例：A1组（无肺动脉高压、主动脉给药）、A2组（无肺动脉高压、中心静脉给药）、B1组（肺动脉高压、主动脉给药）、B2组（肺动脉高压、中心静脉给药）。记录术前（T0）、输注鱼精蛋白之前（T1）、输注后1 min（T2）、3 min（T3）、5 min（T4）、10 min（T5）、15 min （T6）、25 min（T7）各时间点肺动脉压（PAP）、肺静脉压（PVP）、中心静脉压（CVP）、气道峰压（Ppeak）、平均气道压（Pmean）等参数，并采静脉血测血清中各时间点血栓素 B2（TXB2）的水平。结果输注鱼精蛋白后，经中心静脉给药 A2组及 B2组 PAP 、PVP 、CVP 、Ppeak 、Pmean 均高于经主动脉给药的 A1组及 B1组（P ＜0．05）；给药后（T2～ T7）4组患者血中 TXB2浓度较术前（T0）均明显升高（P＜0．05），经中心静脉给药的 A2组及 B2组较主动脉给药的 A1组及 B1组升高更为显著（P＜0．01）。结论心脏直视术后输注鱼精蛋白经主动脉给药较中心静脉给药可明显减少 TXB2的释放，可避免鱼精蛋白直接进入肺循环刺激肺血管和气管平滑肌产生强烈痉挛，对体外循环术后患者的肺循环影响较小，特别是合并有肺动脉高压的患者。