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目的探讨吸入一氧化氮(Nitric oxide,NO)对婴幼儿体外循环手术中肺功能的影响。方法将30例患室间隔缺损的婴幼儿随机分为对照组和NO组,NO组在体外循环期间吸入40 ppm NO直至关胸。体外循环前和术后气管插管未拔前0-1h、1-2h、2-3h测定气道压、吸入氧浓度和呼气末二氧化碳浓度(ETCO2),并分别在同时点采动脉血进行血气分析,计算肺泡死腔率(VD/VT)肺、泡动脉血氧分压差(P(A-a)O2)、动脉血氧含量(CaO2)和肺泡氧合指数(OI),记录术后呼吸机支持时间。体外循环前、主动脉开放后1、5、10min分别取右上肺静脉血和右心房血用于测定丙二醛(MDA)、超氧化物歧化酶(SOD)。结果与NO组相比,对照组再灌注后VD/VT、P(A-a)O2,OI明显升高(P<0.05),CaO2下降(P<0.01);MDA明显升高(P<0.05);SOD明显降低(P<0.01)。结论婴幼儿体外循环术中存在明显肺损害,表现为一些亚临床性肺功能损伤。吸入40 ppm NO对体外循环期间肺功能有保护作用。
Objective To investigate the effect of nitric oxide (NO) on pulmonary function in infants undergoing cardiopulmonary bypass. Methods Thirty patients with ventricular septal defect were randomly divided into control group and NO group. In NO group, inhalation of 40 ppm NO during cardiopulmonary bypass until the chest closed. Airway pressure, inspired oxygen concentration and end-tidal carbon dioxide concentration (ETCO2) were measured before cardiopulmonary bypass and before endotracheal intubation 0-1h, 1-2h, 2-3h before arterial blood was drawn Blood gas analysis was performed to calculate the ratio of pulmonary arterial pressure (P (Aa) O2), arterial oxygen content (CaO2) and alveolar oxygenation index (OI) Machine support time. Before CPB, the right upper pulmonary vein and right atrium were taken at 1, 5 and 10 minutes after the aorta was opened for determination of malondialdehyde (MDA) and superoxide dismutase (SOD). Results Compared with NO group, the levels of VD / VT, P (Aa) O2 and OI in control group were significantly increased (P <0.05) and CaO2 decreased (P <0.01) SOD was significantly lower (P <0.01). Conclusion There are obvious pulmonary lesions during cardiopulmonary bypass in infants and young children, showing some subclinical pulmonary dysfunction. Inhalation of 40 ppm NO has protective effects on lung function during cardiopulmonary bypass.