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目的 观察前列地尔和(或)乌司他丁(Ulinastatin)对小儿体外循环后炎性反应的影响及其肺保护作用.方法 选择择期行体外循环下房室缺修补术患儿58例.随机分为4组:对照组(C组14例)、前列地尔组(P组15例)、乌司他丁组(U组15例)、前列地尔联合鸟司他丁组(PU组14例).观察患儿血流动力学变化,总机械通气时间和ICU留治时间.麻醉诱导后CPB前(T、)、主动脉开放30 min(T2)、2 h(T3)、6 h(T4)、24 h(T5)5个时点采集桡动脉血测最中性粒细胞(PMN),血浆中白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子(TNF)-α和基质金属蛋白酶-9(MMP-9)的含量.于T1、T2、T2记录吸入氧浓度和动脉血气计算肺泡氧合指数(OI).结果 与C组比较,其他3组在T2、T3时PMN、IL-6、IL-8、TNF-α的水平明显降低(均P<0.05),其中PU组最低.U组、PU组患儿血浆IL-10水平在T2、T3明显高于C组,而MMP-9水平明显低于C组(均P<0.05),P组则与C组差异无统计学意义.在T2时其他3组OI值明显高于C组(均P<0.05).PU组机械通气时间明显短于C组(P<0.05).结论 CPB中同时使用前列地尔和乌司他丁可减轻体外循环后炎性反应从而保护肺功能.

Objective To investigate the therapeutic effects of alprostadil (Lipo-PGE1) and Ulinastatin on inflammatory response and lung injury after cardiopulmonary bypass (CPB) in pediatric patients with congenital heart diseases. Methods 58 children with congenital heart diseases, including atrial septal defect,ventricular septal defect, and atrioventricular septal defect, scheduled to undergo CPB,aged 4-72 months, were randomly divided into 4 groups: alprostadil Group P (n = 15) receiving alprostadil central vein until the end of operation, Group U (n = 15) receiving ulinastatin 20 000 U/kg divided into several doses to be added into the prime solution, Group PU (n = 14) receiving alprostadil and ulinastatin according to the above protocols, and Group C (control group, n = 14) receiving normal saline of the equal volume. Electrocardiogram (ECG) ,heart rate (HR),pulse oxygen saturation (SpO2), and mean arterial pressure (MAP) were continuously monitored during operation. Duration of mechanical ventilation and staying in ICU were also recorded. Plasma neutrophil (PMN), IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMP-9) levels in the radial arterial blood samples were measured after induction of anesthesia before CPB (T1),30 minutes and (T2),2 hours (T3),6 hours (T4), and 24 hours (T5) after the declamping of aorta. Inhaled oxygen concentration and arterial blood gas analysis were recorded at T1 ,T2 , and T3 for calculation of oxygenation index (OI). Results There were no significant differences in the MAP and HR among these four groups at any time points (all P > 0.05). The umbers of PMN and the levels of IL-6, IL-8, and TNF-α at T2 and T3 of Groups P,U, and PU were all significantly lower than that of Group C (all P < 0.05), with those of Group PU being the lowest. The IL-10 levels at T2 and T3 of Groups U and PU were significantly higher than that of Group C (both P < 0.05), the level of MMP-9 at T2 and T3 of Groups U and PU were significantly lower than that of Group C (all P < 0.05),however, there was not significant difference between Group P and Group C (P >0.05). The Ols at T2 of Groups P, U, and PU were significantly higher than that of Group C (all P < 0.05). The mechanical ventilation time of Groups P, U, and PU were all significantly shorter than that of Group C, and that of Group PU was significantly shorter than that of group C (P < 0.05). Conclusion Decreasing the inflammatory response after CPB, alprostadil and ulinastatin used during CPB effectively reduce the pulmonary injury via inhibition of the neutrophil activation and cytokines release.