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目的 探讨法乐四联症 (tetralogyofFallot,TOF)根治术中 ,肺动脉灌注低温肺保护液对肺损伤的保护作用。 方法 64例行TOF根治术的患儿随机分为肺保护组 34例 ,对照组 30例。肺保护组患儿体外循环期间肺动脉灌注低温肺保护液 ,对照组患儿常规行TOF根治术。术前和术后 0、6、1 2、2 4、48h监测患儿血流动力学、呼吸功能、血浆脂质过氧化物丙二醛 (MDA)、肿瘤坏死因子α(TNF α)的变化。收集患儿术后 6h气管吸出物 ,检测其炎性介质IL 6、IL 8水平。术后取患儿右下肺组织 ,观察组织形态学改变。 结果 肺保护组患儿术后 6、1 2、2 4h血氧指数高于对照组 (分别t =2 40 0 ,P <0 0 5 ;t=3 898,P <0 0 1 ;t=3 339,P <0 0 1 ) ;呼吸机辅助通气时间和ICU监护时间短于对照组 (分别t=- 2 652 ,P <0 0 5 ;t =- 2 0 81 ,P <0 0 5) ;术后 0、6h血浆MDA水平低于对照组(分别t=- 4 2 55 ,P <0 0 1 ;t=- 2 372 ,P <0 0 5) ;术后 0、6、2 4h血浆TNF α水平低于对照组 (分别t=3 1 1 2 ,P <0 0 1 ;t=3 0 72 ,P <0 0 1 ;t=2 30 6 ,P <0 0 5) ;气管吸出物中IL 6 ,IL 8水平低于对照组 (分别t=- 2 41 9P <0 0 5 ;t=- 2 61 3P <0 0 1 )。肺组织活检病理检查结果 ,对照组肺组织可见炎症细胞浸润、肺间质水肿
Objective To investigate the protective effect of pulmonary hypothermic pulmonary protection solution on lung injury in radical surgery of tetralogy of Fallot (TOF). Methods Totally 64 children with TOF were randomly divided into lung protection group (34 cases) and control group (30 cases). Pulmonary arterial perfusion hypothermia lung protection solution during CPB children’s pulmonary protection group and TOF group were routinely performed in control group. The Changes of Hemodynamics, Respiratory Function, Plasma Lipid Peroxide Malondialdehyde (MDA) and Tumor Necrosis Factor α (TNF α) in Children with Pretreatment and Postoperative 0, 6, 1, 2, . Tracheal aspirates were collected at 6 hours after operation, and the levels of IL-6 and IL-8 in the inflammatory mediators were detected. After surgery, the right lower lungs were removed and histological changes were observed. Results The blood oxygen index of the lung protection group was significantly higher than that of the control group at 6,1,22 h (t = 2 40 0, P <0 05; t = 3 898, P 0 01; t 3 339, P <0.01). The duration of ventilator assisted ventilation and ICU monitoring was shorter than that of the control group (t = -2652, P <0 05; t = - 2 0 81, P 0 05, respectively) The levels of plasma MDA at 0 and 6 hours after operation were lower than those in the control group (t = - 4 2 55, P 0 01; t = -2 372, P 0 05) α levels were lower in the tracheal aspirate than those in the control group (t = 3 1 1 2, P 0 01; t 3 0 72, P 0 01; t 2 306, P 0 05) The levels of IL-6 and IL-8 were lower than those of the control group (t = - 2 41 9P <0 05; t = - 2 61 3P <0 0 1, respectively). Pulmonary biopsy pathological examination results, the control group showed inflammatory cell infiltration of lung tissue, interstitial edema