本文關(guān)鍵詞：小兒主動(dòng)脈弓手術(shù)中SACP與DHCA應(yīng)用效果的比較及烏司他丁對腦損傷的影響　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 兒童 主動(dòng)脈弓 心肺轉(zhuǎn)流術(shù) 胰蛋白酶抑制劑 兒童 主動(dòng)脈弓 腦損傷 心肺轉(zhuǎn)流術(shù)

【摘要】：第一部分小兒主動(dòng)脈弓手術(shù)中SACP與DHCA應(yīng)用效果的比較 目的比較選擇性順行性腦灌注（selective antegrade cerebralperfusion，SACP）與深低溫停循環(huán)（deep hypothermic circulatory arrest，DHCA）在小兒主動(dòng)脈弓手術(shù)中的應(yīng)用效果。 方法收集我院2008年1月至2011年7月53例在體外循環(huán)（cardiopulmonary bypass，CPB）下行主動(dòng)脈縮窄（coarctation of aorta，CoA）或主動(dòng)脈弓中斷（interrupted aortic arch，IAA）合并心內(nèi)畸形矯治術(shù)患兒的臨床資料，統(tǒng)計(jì)其CPB時(shí)間、主動(dòng)脈阻斷時(shí)間、DHCA或SACP時(shí)間、手術(shù)時(shí)間、最低鼻咽溫、最低直腸溫等CPB轉(zhuǎn)流情況，及術(shù)后24h尿量、術(shù)后24h胸腔引流量、正性肌力藥物得分、清醒時(shí)間、機(jī)械通氣時(shí)間、ICU停留時(shí)間、死亡、神經(jīng)系統(tǒng)并發(fā)癥發(fā)生情況、急性腎功能衰竭發(fā)生情況、低心排出量綜合征發(fā)生情況。根據(jù)術(shù)中采用的腦保護(hù)方法將53例患兒分為DHCA組（n=23）和SACP組（n=30），對其術(shù)中體外循環(huán)轉(zhuǎn)流情況和術(shù)后恢復(fù)情況進(jìn)行比較。 結(jié)果與DHCA組比較，，SACP組轉(zhuǎn)流中最低鼻咽溫和最低直腸溫顯著升高（P0.05），術(shù)后24h胸腔引流量、術(shù)后機(jī)械通氣時(shí)間、術(shù)后ICU停留時(shí)間顯著降低（P0.05）。兩組死亡率、神經(jīng)系統(tǒng)并發(fā)癥、急性腎功能衰竭和低心排出量綜合征發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論小兒主動(dòng)脈弓手術(shù)中SACP與DHCA的腦保護(hù)效果相似。SACP有利于術(shù)后呼吸功能的恢復(fù)，減少術(shù)后出血和ICU停留時(shí)間。 第二部分烏司他丁對體外循環(huán)下主動(dòng)脈弓手術(shù)患兒腦損傷的影響 目的評價(jià)烏司他丁對體外循環(huán)（cardiopulmonary bypass，CPB）下主動(dòng)脈弓手術(shù)患兒腦損傷的影響。 方法選擇擬在CPB下行主動(dòng)脈縮窄（coarctation of aorta，CoA）或主動(dòng)脈弓中斷（interrupted aortic arch，IAA）合并心內(nèi)畸形矯治術(shù)的患兒20例，性別不限，年齡1~24月，體重3~12kg，美國麻醉醫(yī)師協(xié)會（American society of anesthesiologists，ASA）分級Ⅲ或Ⅳ級，術(shù)中擬使用選擇性順行性腦灌注（selective antegrade cerebral perfusion，SACP）。采用隨機(jī)數(shù)字表法，將20例患兒隨機(jī)分為2組（n=10）：烏司他丁組（U組）和對照組（C組）。U組給予烏司他丁2萬U/kg，用生理鹽水將烏司他丁稀釋至1萬U/ml，麻醉誘導(dǎo)后經(jīng)頸內(nèi)靜脈注射1/3量，CPB開始時(shí)和主動(dòng)脈開放前約5min各使用1/3量；C組在相同時(shí)間點(diǎn)給予等容積的生理鹽水。分別于麻醉誘導(dǎo)后（T1）、主動(dòng)脈阻斷后10min（T2）、主動(dòng)脈開放后10min（T3）、CPB結(jié)束（T4）、CPB結(jié)束后6h（T5）、CPB結(jié)束后24h（T6）時(shí)采集橈動(dòng)脈血3.5ml，酶聯(lián)免疫吸附測定（enzyme-linked immunosorbent assay，ELISA）法測定血漿S100B蛋白（S100B protein，S100B）和神經(jīng)元特異性烯醇化酶（neuronspecific enolase，NSE）濃度。 結(jié)果兩組T1時(shí)血漿S100B及NSE濃度無統(tǒng)計(jì)學(xué)差異（P＞0.05）；與T1時(shí)比較，兩組血漿S100B及NSE濃度在T2~5時(shí)均升高（P＜0.05），T6時(shí)差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；與C組比較，U組T2~5時(shí)血漿S100B及NSE濃度降低（P＜0.05）。 結(jié)論烏司他丁可減輕CPB下主動(dòng)脈弓手術(shù)患兒的腦損傷。
[Abstract]:Part I comparison of the effect of SACP and DHCA in pediatric aortic arch surgery Objective to compare selective antegrade cerebral perfusion with selective antegrade cerebralperfusion. Deep hypothermic circulatory arrest. The effect of DHCA in the operation of aortic arch in children. Methods 53 cases of cardiopulmonary bypass were collected from January 2008 to July 2011 in our hospital. The aortic coarctation of coarctation of CoA) or interrupted aortic arch aortic arch were observed. CPB time, aortic occlusion time and SACP time, operation time, minimum nasopharyngeal temperature were calculated. Minimum rectal temperature and other CPB bypass, postoperative 24 h urine volume, postoperative 24 h chest drainage flow, positive muscle strength drug score, waking time, mechanical ventilation time, ICU stay time, death. Complications of nervous system and acute renal failure. According to the method of cerebral protection, 53 cases were divided into DHCA group (n = 23) and SACP group (n = 30). To compare the condition of cardiopulmonary bypass (CPB) and postoperative recovery. Results compared with the DHCA group, the lowest nasopharyngeal temperature and minimum rectal temperature in the DHCA group increased significantly (P 0.05), the thoracic drainage volume 24 hours after operation, and the postoperative mechanical ventilation time. Postoperative ICU residence time significantly decreased P0.050.Mortality and neurological complications were observed in both groups. There was no significant difference in the incidence of acute renal failure and low cardiac output syndrome (P 0.05). Conclusion the cerebral protective effects of SACP and DHCA in pediatric aortic arch surgery are similar. SACP is beneficial to the recovery of respiratory function and the reduction of postoperative bleeding and ICU residence time. Effect of ulinastatin on brain injury in children undergoing aortic arch surgery under cardiopulmonary bypass Objective to evaluate the effect of ulinastatin on brain injury in children undergoing aortic arch operation under cardiopulmonary bypass (CPB). Methods coarctation of aorta was performed on CPB. Coa) or aortic arch interrupted aortic archIA) combined with intracardiac malformation correction in 20 cases, sex was not limited, age ranged from 1 to 24 months. The body weight was 312kg, and American society of anestheologists (ASA) was graded 鈪

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