【摘要】 目的　评价联合应用保护性机械通气和前列腺素 E1 (PGE1 )对婴幼儿体外循环后急性肺损伤(AL I)的保护作用。方法　婴幼儿体外循环术后 AL I患者 18例 ,随机分为 A、B两组 ,每组 9例。A组采用保护性机械通气策略治疗 ,低潮气量 (6～ 8ml/ kg) ,高呼气末正压 (6～ 12 cm H2 O) ,限制吸气峰压 (<35 cm H2 O) ,适当允许高碳酸血症 (Pa CO2 ≤ 6 0 mm Hg)。 B组在施行保护性机械通气的基础上联合静脉应用 PGE1 ,剂量为 30～10 0 ng/ (kg·m in) ,连用 7～ 10天。观察两组患儿的临床转归 ,并监测 4 8小时内肺动态顺应性、氧合指数、血浆肿瘤坏死因子 (TNFα)和白细胞介素 - 8(IL- 8)的含量变化。结果　死亡 1例 (5 .6 % ) ,其余无严重并发症发生。在治疗后 4 8小时内的各个时点 ,B组肺的动态顺应性显著高于 A组 (P <0 .0 5 ) ,氧合指数非常显著降低 (P <0 .0 1) ,血浆 TNFα和 IL- 8含量显著低于 A组 (P <0 .0 1)。结论　二者联合应用具有协同作用 ,可明显提高婴幼儿体外循环后 AL I的治疗效果更多还原

【Abstract】 Objective To assess the efficacy of combined lung protective mechanical ventilation and Prostaglandin E 1 strategy on acute lung injury induced by cardiopulmonary bypass in infants.Methods 18 infants with acute lung injury (ALI)after cardiopulmonary bypass were randomly divided into two groups:Group A and group B,9 patients in each group.Group A received protective lung mechanical ventilation strategy as follow:small tidal volume (6～8ml/kg),high PEEP (6～12cmH 2O),limited peak pressure (<35cmH 2O),permissive hypercapnia (PaCO 2≤60mmHg); Group B received both the protective mechanical ventilation strategy and intravenous Prostaglandin E 1 (PGE 1).The dose of PGE 1 was 30~100 ng/(kg·min) into central vein for 7~10 days.The clinical results of two groups were observed,and lung compliance,oxygenation index,TNF α and IL-8 of the plasma were determined at different time points during the 48h of treatment.Results In these patients,only one died (5.6%) and another infant had barotrauma in the early period of treatment.Compared with our past similar patients,the mortality and morbidity remarkably declined.On the other hand,the dynamic lung compliance of group B was higher than that of group A (P<0.05).The oxygenation index in group B was significantly lower than that in group A (P<0.05).The level of TNF αand IL-8 in group B was lower than that in group A (P<0.01).Conclusion A combined use of protective lung mechanical ventilation and intravenous Prostaglandin E 1 shows synergetic therapeutic effect on the ALI after cardiopulmonary bypass in infants.更多还原