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目的 探讨联合应用外源性肺表面活性物质 (PS)和保护性肺通气策略对体外循环后急性肺损伤 (ALI) /急性呼吸窘迫综合征 (ARDS)的治疗效应。方法 婴幼儿体外循环术后ALI/ARDS患者 16例 ,随机分为A和B两组 ,A组 9例采用保护性肺机械通气治疗 ;B组 7例在保护性肺通气治疗基础上经气管插管联合应用外源性PS(15 0mg/kg体重 )。观察两组患儿的临床转归 ,并监测 48h内肺动态顺应性 (Cdyn)、氧合指数 (OI)、血浆肿瘤坏死因子 (TNF α)的水平。结果与以往同类病例的治疗结果相比 ,本组患儿死亡率 (6.2 5 % )和并发症显著降低。在治疗后 48h内的各个时点 ,B组Cdyn显著高于A组 (P <0 .0 5 ) ,OI和TNF α的水平显著低于A组 (P <0 .0 5～0 .0 1)。结论 外源性PS与保护性肺通气具有协同作用 ,二者联合应用可明显提高体外循环后ALI/ARDS的治疗效应
Objective To investigate the therapeutic effect of combined exogenous pulmonary surfactant (PS) and protective pulmonary ventilation on acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) after cardiopulmonary bypass. Methods Sixteen infants with ALI / ARDS after cardiopulmonary bypass were randomly divided into two groups: A and B, and 9 cases in group A were treated with protective pulmonary mechanical ventilation. In group B, 7 cases were treated with protective pulmonary ventilation Tubular combination of exogenous PS (150mg / kg body weight). The clinical outcomes of both groups were observed and the levels of Cdyn, OI and TNFα were monitored within 48 hours. Results Compared with the treatment results of the same kind of cases in the past, the mortality rate (6.2 5%) and complication in this group were significantly lower. At each time point within 48 hours after treatment, the level of Cdyn in group B was significantly higher than that in group A (P <0.05), and the levels of OI and TNFα were significantly lower than those in group A (P <0.05-0.01 ). Conclusion Exogenous PS and protective pulmonary ventilation have a synergistic effect, and the combination of the two can significantly improve the therapeutic effect of ALI / ARDS after cardiopulmonary bypass