七氟烷预处理在婴幼儿体外循环中对肺功能的保护作用

摘要

目的：观察七氟烷预处理在婴幼儿体外循环（CPB）心脏直视手术中对肺功能的影响，探讨其肺保护作用及可能机制。方法：选择1岁以内行室间隔缺损修补术的患儿60例，按照随机数字表法分为预处理组和对照组（n＝30）。预处理组患儿在全身麻醉诱导完成气管插管后开始持续吸入1.0最小肺内浓度（MAC）七氟烷，直至 CPB 开始；对照组患儿不吸入七氟烷。记录2组患儿的呼吸机支持时间，比较2组患儿在主动脉阻断前（T0）、主动脉开放30 min （T1）、CPB 结束后2 h （T2）和 CPB 结束后6 h （T3）4个时间点气道平台压（Pplate）、肺顺应性（CL）、氧合指数（OI）、肺泡-动脉氧分压差（A-aDO2）、呼吸指数（RI）及肺隔离白细胞和中性粒细胞计数。结果：与对照组比较，预处理组患儿呼吸机支持时间明显缩短（P ＜0.05）。与 T0时间点比较，2组患儿在 T1、T2和 T3时间点 CL 和 OI 均明显降低（P ＜0.05或 P ＜0.01），Pplate 、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显升高（P ＜0.05或 P ＜0.01）。与对照组比较，在 T1、T2和 T3时间点预处理组患儿 CL 和 OI 均明显升高（P ＜0.05或 P ＜0.01），Pplate 、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显降低（P ＜0.05或 P ＜0.01）。结论：在婴幼儿 CPB 手术中应用七氟烷预处理可以减少白细胞的黏附，保护患儿的肺功能，值得临床推广应用。%Objective:To observe the influence of sevoflurane pretreatment in the lung function of the infants during heart operation by cardiopulmonary bypass (CPB), and to explore its lung protection and possible mechanism.Methods:Sixty infants with ventricular septal defect were enrolled at age less than 1 year old and randomly assigned to pretreatment group and control group (n=30).After the induction of general anesthesia and tracheal intubation,the patients in pretreatment group received continuous inhalation of 1.0 MAC sevoflurane until the beginning of CPB.Inhale sevoflurane was absent in control group.The duration of ventilator support of the infants in two groups was recorded.The Pplate,CL,OI,A-aDO2 ,RI,the number of leukocytes and neutrophils segregated in lung of the patients were compared between two groups at the four time points T0 (before aorta clamping),T1 (30 min after aorta declamping),T2,and T3 (2 h and 6 h after CPB).Results:Compared with control group,the duration of ventilator support of the infants in pretreatment group was obviously shortened (P <0.05).In each group,the CL and OI were significantly decreased (P < 0.05 or P < 0.01),while the Pplate, A-aDO2 ,RI,the number of leukocyte and neutrophils segregated in lung were significantly increased (P <0.05 or P <0.01)at T1,T2,T3 time points compared with T0 time point.The CL and OI in pretreatment group were significantly increased (P <0.05 or P <0.01);the Pplate,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung in pretreatment group were significantly decreased at T1,T2,and T3 (P <0.05 or P <0.01) compared with control group.Conclusion:Sevoflurane pretreatment might play a role in decreasing the leukocyte adhesion and protecting the lung function in the infants during opening heart operation by CPB.