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目的观察乌司他丁对先天性心脏病(先心病)患儿肺动脉高压体外循环(CPB)后细胞因子释放及肺功能的影响,探讨其可能的肺保护机制。方法心功能Ⅱ~Ⅲ级的50例先心病(房间隔缺损或室间隔缺损)患儿,随机分为乌司他丁组和对照组,每组各25例。乌司他丁组予乌司他丁2万U.kg-1,1/3量用于CPB前麻醉后,1/3加入预充液,另1/3复温时给予。对照组用等容积9 g.L-1盐水代替。记录术中呼吸道峰压。分别于麻醉诱导后、主动脉开放后30 min、2 h、24 h采集动脉血,应用酶联免疫吸附试验法测定其血浆TNF-α、基质金属蛋白酶-9(MMP-9)水平。结果二组呼吸道峰压在停CPB和术后均有升高,但对照组升高更显著(Pa<0.05);CPB后患儿TNF-α、MMP-9生成明显增加(Pa<0.05),乌司他丁组在主动脉开放30 min、24 h MMP-9、TNF-α水平均较对照组明显降低(Pa<0.01)。结论 CPB前应用乌司他丁能有效抑制TNF-α、MMP-9释放,降低呼吸道压力,减轻CPB后急性肺损伤,具有一定的肺保护作用。
Objective To investigate the effects of ulinastatin on cytokine release and pulmonary function after cardiopulmonary bypass (CPB) in children with congenital heart disease (CHD) and to explore its possible mechanism of lung protection. Methods Fifty children with congenital heart disease (atrial septal defect or ventricular septal defect) with cardiac function Ⅱ ~ Ⅲ were randomly divided into ulinastatin group and control group, with 25 cases in each group. Ulinastatin group Ulinastatin 20000 U.kg-1/1/3 for the pre-CPB anesthesia, 1/3 added to the priming solution, the other 1/3 when rewarmed. The control group with an equal volume of 9 g.L-1 saline instead. Record intraoperative peak airway pressure. Arterial blood was collected at 30 min, 2 h and 24 h after anesthesia induction, and plasma TNF-α and MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA). Results The peak airway pressure of the two groups both increased after stopping CPB and postoperatively, but the control group increased more significantly (Pa0.05). After CPB, the levels of TNF-α and MMP-9 were significantly increased (P0.05) The levels of MMP-9 and TNF-α in the ulinastatin group were significantly lower than those in the control group at 30 min and 24 h (P <0.01). Conclusion The application of ulinastatin before CPB can effectively inhibit the release of TNF-α and MMP-9, reduce the airway pressure and relieve the acute lung injury after CPB, and has certain lung protection effect.