一氧化氮对先天性心脏病患者 肺泡表面活性物质影响.docVIP

一氧化氮对先天性心脏病患者 肺泡表面活性物质影响 　【摘要】 目的 研究先天性心脏病患者尤其是合并肺动脉高压患者手术后经吸入一氧化氮后，支气管肺泡灌洗液中肺泡表面活性物质（PS）的浓度、成分的变化，及随吸入时间的延长而发生的改变。方法 将34例先天性心脏病伴肺动脉高压并实施体外循环手术的患儿,随机分为INO组(外源性NO吸入治疗组) 和对照组，每组17例。分别于术前和术后30 min、2 h、6 h检测支气管肺泡灌洗液中总磷脂、饱和卵磷脂、总蛋白的含量，并计算氧合指数。结果 体外循环术后两组PS水平显著降低，氧合指数升高。术后2 h、6 h后INO组PS水平显著低于对照组(Plt;0.01)，其余时点两组无显著差异，两组间氧合指数无显著性差异(Pgt;0.05)。结论 体外循环可明显降低PS水平，应用外源性NO进一步降低PS水平，但对呼吸功能无明显影响。 【关键词】 一氧化氮 体外循环 表面活性物质 支气管肺泡灌洗液 肺动脉高压 Abstract: OBJECTIVE To investigate the effect of inhaling nitric oxide(NO) on pulmonary surfactant(PS) including the change of concentration and composition with the time in the patients with congenital heart disease complicating pulmonary hypertension. METHODS 34 children with congenital heart disease associated with pulmonary hypertension undergoing heart surgery with extracorporeal circulation(ECC) were randomly divided into two groups: inhaled NO group and control group. The bronchoalveolar lavage fluid (BALF) was obtained for analyzing content of total phospholipids (TPL), saturate phosphatidy choline (SPC),total protein (TP) and the oxygenation index (QI) before and after surgery at 30 min,2 h and 6 h. RESULTS The PS activity was decreased and the QI was increased significantly after ECC in both the control group and inhaled NO group. The PS activity in the inhaled NO group was markedly decreased compared with the control group after ECC at 2 h and 6 h (Plt;0.01) and there were no difference after ECC at 30 min (Pgt;0.05).There were no significant differences in the oxygenation index between the two groups(Pgt;0.05).CONCLUSION ECC reduces pulmonary surfactant activity signifficantly. The pulmonary surfactant was lower after exogenous inhaled NO. There were no significant effects on respiratory function after ECC. Key words： Nitric oxide;Extracorporeal circulation;Pulmonary surfactant;Bronchoalveolar lavage fluid;Pulmonary hypertension 吸入一氧化氮（inhaled nitric oxide，INO）具有降低肺动脉压，减少肺内分流和改善氧合的作用。INO在体外循环(extracorporeal circulation，ECC) 后对肺顺应性和肺泡表面活性