本文選題：嬰兒　切入點(diǎn)：烏司他丁　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:體外循環(huán)(cardiopulmonary bybass CPB)是進(jìn)行心臟直視手術(shù)中的一項(xiàng)重要的輔助技術(shù)。體外循環(huán)的臨床使用已經(jīng)有60余年的歷史,它在器材設(shè)備、理論水平及臨床應(yīng)用都發(fā)生了很大變化�，F(xiàn)階段對于體外循環(huán)的研究非常多,但是CPB術(shù)后并發(fā)癥尤其是肺損傷依然存在。烏司他丁(Ulinastatin UTI)是蛋白酶抑制劑的一種,國內(nèi)外研究表明它可以抑制炎癥,保護(hù)肺功能。對于烏司他丁應(yīng)用于CPB的研究也非常廣泛,但是對于嬰幼兒的報(bào)道并不多。本課題的目的在于研究烏司他丁(UTI)在嬰幼兒先天性心臟病心內(nèi)直視手術(shù)中的作用。通過對不同時(shí)間點(diǎn)的中性粒細(xì)胞彈性蛋白酶(NE)、炎性介質(zhì)(TNF-α,IL-6)血漿濃度的測定以及監(jiān)測呼吸指數(shù)(RI)和氧合指數(shù)(OI)來研究對于嬰兒烏司他丁在體外循環(huán)中的肺保護(hù)作用。方法:選擇在體外循環(huán)輔助下行室間隔缺損修補(bǔ)術(shù)的患兒50例(男24例,女26例),隨機(jī)分為兩組,試驗(yàn)組(U組)和對照組(C組),每組均為25例,ASA分級均為Ⅱ級,年齡在2個(gè)月~6個(gè)月,體重在3kg~6kg。兩組患兒均采用相同的麻醉方法、體外方法和手術(shù)步驟。試驗(yàn)組(U組)的烏司他丁的用量為2萬U/kg,用生理鹽水將其稀釋至10毫升,5毫升與主動(dòng)脈插管前由中心靜脈緩慢推入,另外5毫升直接加入到體外循環(huán)的預(yù)沖液中,隨機(jī)轉(zhuǎn)入體內(nèi)。對照組(C組)用生理鹽水來代替,方法同上。分別于手術(shù)切皮前(T0),腔靜脈開放時(shí)(T1),CPB結(jié)束4小時(shí)(T2),CPB結(jié)束24小時(shí)(T3)取頸內(nèi)靜脈血4毫升,利用酶聯(lián)免疫法(Elisa)來測量NE,TNF-α以及IL-6的濃度。呼吸功能監(jiān)測:分別于T0~T3這四個(gè)時(shí)間點(diǎn)取橈動(dòng)脈血1毫升行血?dú)夥治?記錄PaO2,PaCO2和紅細(xì)胞壓積(Hct),記錄相對應(yīng)時(shí)間點(diǎn)呼吸機(jī)的吸入氧濃度(FiO2),利用公式計(jì)算出呼吸指數(shù)(RI)與氧合指數(shù)(OI)。結(jié)果:在T0時(shí),兩組患兒的NE,TNF-α,IL-6的水平以及RI,OI的數(shù)值差別無統(tǒng)計(jì)學(xué)意義(P0.05),與T0相比較,在T1~T3時(shí)兩組患兒的血清NE,TNF-α,IL-6的水平上升(P0.05),兩組患兒的RI值增大(P0.05)、OI值減小(P0.05)。與C組相比較,U組患兒在T1~T3時(shí)的血清NE,TNF-α,IL-6的水平下降(P0.05),RI值減小(P0.05)、OI值增大(P0.05)。結(jié)論:1體外循環(huán)(CPB)可以促進(jìn)機(jī)體釋放炎性介質(zhì)和NE,造成肺功能的損傷。2烏司他丁可以抑制嬰兒CPB后炎性介質(zhì)以及NE的釋放而保護(hù)肺功能。
[Abstract]:Objective: cardiopulmonary bybass (CPB) is an important assistant technique in open heart surgery.Cardiopulmonary bypass (CPB) has been used in clinic for more than 60 years. It has changed greatly in equipment, theory and clinical application.There are many studies on cardiopulmonary bypass at present, but complications, especially lung injury, still exist after CPB.Ulinastatin UTI is a protease inhibitor, which can inhibit inflammation and protect lung function.Studies on the use of ulinastatin in CPB are also extensive, but there are few reports of infants and young children.The purpose of this study was to study the role of ulinastatin (UTI) in open heart surgery in infants with congenital heart disease.The pulmonary protective effect of ulinastatin on infants during cardiopulmonary bypass (CPB) was studied by measuring the plasma concentrations of neutrophil elastase, TNF- 偽 and IL-6, and monitoring respiratory index (RI) and oxygenation index (OII) at different time points.Methods: fifty children (24 males and 26 females) with ventricular septal defect repair assisted by cardiopulmonary bypass were randomly divided into two groups: experimental group (group U) and control group (group C).The age ranged from 2 months to 6 months and the body weight was 3 kg to 6 kg.The two groups were treated with the same anesthetic method, extracorporeal method and surgical procedure.The dosage of ulinastatin was 20 000 U / kg, diluted with normal saline to 10 ml / 5 ml and slowly pushed through the central vein before aortic catheterization, and the other 5 ml was added directly to the cardiopulmonary bypass (CPB) preflushing solution.Into the body at random.The control group (group C) was replaced by normal saline.The concentration of NETNF- 偽 and IL-6 were measured by enzyme-linked immunosorbent assay (Elisa).Respiratory function monitoring: 1 ml of radial artery blood was taken at the four time points of T0~T3 for blood gas analysis. PaO2 and HCT were recorded. The inhaled oxygen concentration of ventilator was recorded at the corresponding time point. The respiratory index (RI) and oxygenation index (Oi) were calculated by using the formula.緇撴灉:鍦═0鏃，

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