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目的观察间断肺通气对婴儿体外循环(CPB)的肺保护作用,并探讨其机制。方法选取60例1岁以内行室间隔缺损修补术的患儿,随机分为两组。对照组于CPB开始后停止通气;处理组于CPB开始心脏停跳后膨肺(用手挤压气囊,使气道压力升到25—30cmH2O,维持3—5秒,重复5次),将肺内血液排出,然后静态膨肺(4—8cmH2O),并每隔10min膨肺5次。两组患儿均于腔静脉开放后恢复机械通气。记录术后呼吸机通气和重症监护时间,在主动脉阻断前、阻断10min和开放10min分别采集左右心房血测定白细胞计数,并测定术前、主动脉阻断10min、开放10min、CPB后2h、6h、12h、24h和48h时血浆NE、TNF-帷L-6、IL-8含量。结果术后机械通气和重症监护时间处理组均明显低于对照组(P<0.01);在主动脉阻断10min和开放10min时,对照组右心房血白细胞计数明显高于左心房血(P<0.01);NE、TNF-a、IL-6和IL-8浓度在主动脉阻断10min、开放10min、CPB后2h、6h、12h时处理组低于对照组(P<0.01)。结论在婴儿CPB过程中持续静态膨肺并间断压力膨肺,可以减少白细胞的粘附、降低炎性因子水平,有较好的肺保护作用。
Objective To observe the lung protection effect of intermittent pulmonary ventilation on infant cardiopulmonary bypass (CPB) and to explore its mechanism. Methods Sixty children with ventricular septal defect repaired within 1 year of age were randomly divided into two groups. The control group was ventilated after the start of CPB. The treatment group was inflated by CPB after cardiac arrest (squeeze the balloon by hand to raise the airway pressure to 25-30cmH2O for 3-5 seconds and repeat 5 times) The blood is excreted and then statically inflated (4-8 cmH2O) and inflated 5 times every 10 min. Both groups were resumed mechanical ventilation after vena cava opening. Ventilation and intensive care time were recorded. Before the aorta occlusion, the white blood cell counts were collected after occlusion of 10 min and 10 min respectively. The preoperative and postoperative aorta occlusion 10 min, 10 min, 2 h after CPB , 6h, 12h, 24h and 48h plasma NE, TNF-hang L-6, IL-8 content. Results The time of mechanical ventilation and intensive care unit postoperatively were significantly lower than those of the control group (P <0.01). In the aorta occlusion 10 min and open 10 min, the right atrial blood leucocyte count of the control group was significantly higher than that of the left atrial blood (P < 0.01). The concentrations of NE, TNF-a, IL-6 and IL-8 were lower in the aorta 10 min, 10 min, 2 h, 6 h, 12 h after CPB than those in the control group (P <0.01). Conclusions Continuous inflating of the lungs and intermittent pressure inflation in the infant CPB process can reduce leukocyte adhesion, reduce the level of inflammatory cytokines, and have good lung protection.