抑肽酶在体外循环手术中肺保护作用临床观察.docVIP

抑肽酶在体外循环手术中肺保护作用临床观察 　 作者：李永武,刘海霞,王平凡,杨能善 【关键词】 抑肽酶 摘要：目的 临床观察抑肽酶在小儿体外循环手术中对肺损伤的保护作用。方法将78例0.5~2岁先天性心脏病患儿分为抑肽酶用药组（38例）和对照组（40例），对比观察术后肺部并发症发生率、呼吸机应用时间、术后肺泡-动脉血氧压差。结果实验组与对照组比较，肺部并发症发生率低、呼吸机应用时间短、术后肺泡-动脉-血氧分压差低（plt;0.01）。结论 体循环中应用抑肽酶可以减轻肺损伤、保护肺功能。 　　关键词：抑肽酶，体外循环，肺保护 　　Clinical Observation on The Protective Effect of Aprotinin on Lungs in Infants Undergoing Cardiopulmonary Bypass 　　　Abstract: OBJECTIVETo observe the clinical effect of aprotinin on lung protection in infants undergoing cardiopulmonary bypass. METHODS 78 infants with ventricular septal defects aged 0.5~2 years, weight 5~12kg, were randomly divided into two groups. Aprotinin group and control group. Patients in the aprotinin group received dose of aprotinin (50000KIU/kg). The control group received the same volume of saline. Chest X-rays pictures of chest were taken 1 hour, 12 hour, 24 hours after operation for existence of pulmonary complications. Alveolar-arterial oxygen gradient were recorded 1 hour, 4 hours and 24 hours after operation. Time of intubation during ICU were also recorded.RESULTS Compared with the control group, patients in the Aprotinin group showed lower rate of occurrence of pulmonary complications, shorter time of intubation and lower A-aDO2 after operation (Plt;0.01).CONCLUSION This observation suggests that aprotinin may have a protective effect on lungs in infants undergoing CPB. 　　Key words：cardiopulmonary bypass; aprotinin; lung protection 　　体外循环引起的炎性反应是引起婴幼儿术后肺损伤的主要原因。近年的研究发现抑肽酶能通过许多途径降低炎性反应的强度。我们在工作中观察了抑肽酶对婴幼儿体外循环术后肺功能、呼吸机应用时间和肺部并发症发生率的影响，报告如下： 　　1 材料与方法 　　1.1 2000年1月至2003年1月在本科住院的6月-2岁的先天性心脏病室间隔缺损的患儿共78例。分抑肽酶组（38例）和对照组（40例）。两组在平均年龄、彩超测量室间隔缺损大小、肺动脉平均压、体重方面无显著性差别。两组在所选用氧合器种类、体外循环转流及主动脉阻断时间方面无显著性差异。抑肽酶组总转流时间及主动脉阻断时间分别为（62.3±10.35）min及(30.5±8.52)min。对照组分别(60.15±11.25)min及(31.55±7.5)min。全部病例均行气管内插管全麻，定容呼吸机间歇正压通气，采用膜式氧合器，流量80-200ml/kg。术中平均鼻咽温度(28.34±2.12)℃。体内肝素化剂量为3mg/kg，机内预充液肝素含量为2mg/100ml，以ACT监测肝素化水平。停机后1:1鱼精蛋白中和体内肝素。 　　1.2 用药方法及剂量 　　采用德国拜耳（Bayer）公司的特血乐（Trasylol），有效成份为抑肽酶50