ABSTRACT
Objective To study the mechanism of pulmonary injury and protective effect of modified ultrafiltration on lung function in infant open heart surgery.Methods According to the wishes of parents,40 cases of congenital heart disease were divided into without modified ultrafiltration control group (C) and modified ultrafiltration group (M),and parents signed informed consent.The cardiopulmonary bypass (CPB) was used without ultrafiltration in Group C,while with modified ultrafiltration in group M.The pneumodynamic parameters and C3a,C5a,TXA2,LT were measured at specific time points.Results The static pulmonary compliance (Cstat) and oxygen index (OI) were lower,and alveolar-arteria oxygen difference (AaDO2) was higher after CPB in the two groups(P ＜ 0.05).At T3,T4 and T5 time points,the Cstat and OI in Group M was higher than that in Group C; AaDO2 in Group M was lower than that in Group C (P ＜0.05).The levels of C3a and C5a were lower after CPB in the two groups; levels of TXA2,LT were higher after CPB in the C groups.At T2,T3,T4 and T5 time points,the TXA2 and LT in Group M were lower than that in Group C(P ＜0.05).Conclusions The pulmonary injury in pediatric open heart surgery may be concerned with the the alexin(C3a,C5a) activation and I/R.The level of C3a and C5a was considered earlier index of inflammatory reaction and pulmonary injury.Modified ultrafiltration improves pulmonary function due to elevating coloid osmotic pressure and degrading the plasma level of TXA2,LT.
ABSTRACT
ObjectiveTo investigate the role of ischemic postconditioning on lung ischemic/reperfusion injury induced by cardiopulmonary bypass (CPB) in combined mitral and aortic valve replacement,and evaluate the effects of different protocol of ischemic postconditioning,and analyze its possible mechanisms.Methods24 patients diagnosed as rheumatic mitral and aortic valve disease with or without tricuspid valve disease were randomly divided into 3 groups (8 in each):Control group( group A),patients undergoing routine cardiac surgery; Postconditioning group Ⅰ (group B ),patients undergoing routine cardiac surgery and ischemic postconditioning by occlusion of the pulmonary artery of five cycles of 15 s ischemia and 15 s repeffusion before the pulmonary artery totally restoring peffusion; Postconditioning group Ⅱ (group C),patients undergoing routine cardiac surgery and ischemic postconditioning by occlusion of the pulmonary artery of five cycles of 30 s ischemia and 30 s repeffusion before the pulmonary artery totally restoring perfusion.The Oxygenation Index (OI) was measured at pre -operation and 1 h,2 h,3 h,6 h and 12 h after terminating CPB.The plasma contents of MDA were detected by Enzyme-linked Immunosorbent Assay at pre -operation,1 h,3 h,6 h and 12 h after terminating CPB.ResultsCompared with group A and C,OI in group B significantly increased at 1 h,2 h,3 h,6 h after terminating CPB (283.25 ±56.47 vs 384.76 ±29.17 vs 310.50 ±65.71,265.75 ±58.78 vs 381.75 ±29.67 vs 310.50 ±48.17,283.75 ±73.15 vs389.74±39.34 vs 317.87 ±78.41,310.37 ±52.00 vs 401.62 ±4 2.89 vs 337.25 ± 64.06,all P ＜0.05),and the plasma contents of MDA in group B reduced at 1 h,3 h,6 h,12 h after terminating CPB (4.64±0.63 vs 3.88 ±0.20 vs 4.38 ±0.41,5.75±0.49 vs 4.44 ±0.34 vs 5.28 ±0.76,4.42±0.31vs 3.77 ± 0.40 vs 4.35 ± 0.54,3.74 ± 0.31 vs 3.19 ± 0.17 vs 3.64 ± 0.24,all P ＜ 0.05 ), However,there were no significant differences in OI and MDA between group C and A (all P ＞0.05 ).Conclusions Ischemic postconditioning by occlusion of the pulmonary artery of 5 cycles of 15 s ischemia and 15 s reperfusion attenuates lung oxygenation function injury induced by CPB in double valves replacement,and it is possibly mediated by reducing MDA produced by lipid peroxidation.However,ischemic postconditioning by occlusion of the pulmonary artery of 5 cycles of 30 s ischemia and 30 s repeffusion may not have significant protective effect for lung oxygenation function injury induced by CPB in double valves replacement.