Dissertation
Dissertation > Medicine, health > Surgery > Of surgery > Cardiovascular and lymphatic system surgery > Heart

Clinical research of pulmonary artery perfusion with cold HTK solution the immature lung cardiopulmonary bypass injury

Author LiJianAn
Tutor LiuYingLong;WangQiang;LvXiaoDong
School Beijing Union Medical College
Course Surgery
Keywords Lung injury HTK solution Cardiopulmonary bypass
CLC R654.2
Type PhD thesis
Year 2010
Downloads 36
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The first part of pulmonary perfusion with hypothermic HTK solution immature lung protective effect in the the tetralogy's quadruple levy correction surgery [Objective] evaluation of cardiopulmonary bypass (CPB) in pulmonary perfusion with hypothermic HTK solution of the the tetralogy's quadruple levy orthotics in immature the protective effect of the lung. [Method] From January 2009 to June 2009, 24 cases of select the consecutive surgical therapy Kellogg quadruple sign children, including 18 males and 6 females;-month-old March-December, an average of 8.4 ± 2.7 months ; weight 4.5-10kg, with an average of 7.5 ± 1.5kg. Preoperative pulmonary perfusion and control groups were randomly divided into to record general clinical information, and detection After oxygenation index (O1) and alveolar - arterial oxygen difference (AaDO2), serum malondialdehyde (MDA), serum interleukin-6 (IL-6), White mediated Su-8 (IL-8), White mediated Su-10 (1L-10), tumor necrosis factor α (of TNF-α), endothelial prime 1 (ET-1). of P-selectin and soluble cell adhesion molecule -1 (sICAM-1), and analyzed statistically. [Results] The two groups after CPB 0,12,24,48 h oxygenation index were better than the preoperative perfusion group at each time point oxygenation index were significantly higher than the control group, there are significant differences between the two groups trends. The two groups after CPB 0,12,24,48 h AaDO2 are better than before surgery, and at each time point the perfusion group AaDO2 were significantly lower than the control group, but the trend AaDO2 between the two groups was no significant difference. Reperfusion group and a control group of serum IL-6 level immediately after CPB were significantly higher, but the control group is still at a high level until after CPB 48h reperfusion group at each time point after CPB increased the degree lower than those of the control group, and IL-6 levels after CPB 48h preoperative comparison no longer a significant difference; trend of serum IL-6 levels between the two groups were significantly different. Reperfusion group and the control group, serum IL-8 levels immediately after CPB were significantly higher, but the control group is still at a high level until after CPB 48h reperfusion group has been in a similar low-and before CPB 12,24,48 h after CPB level, but the trend of serum IL-8 levels between the two groups failed to show significant differences. Perfusion group and the control group, regardless of CPB, after CPB 0,12,24,48 h serum IL-10 levels had no significant difference in the trend of serum IL-10 levels between the two groups was no significant difference. Control group, serum TNF-α levels immediately after CPB significantly increased after 12h to CPB returned to preoperative levels after CPB perfusion group has been in a similar low level and before CPB 0,12,24,48 h and two serum TNT-α level trends there are significant differences between the groups. Control group, serum levels of sICAM-1 level after CPB significantly increased, until after CPB 48h before recovery to near baseline levels, but still higher than CPB before for high; reperfusion group at all time points after CPB has been with before CPB without significantly with differences, and analysis of variance showed significant differences in serum sICAM-1 level trends exist between the two groups. Control group, serum P-selectin level before CPB after 12h compared with CPB significantly increased, until after CPB 48h before recovery to near baseline levels, while perfusion group after CPB 12h compared with CPB significantly with reducing, the CPB after 24,48 h, although recovery to close CPB before, but still higher than before CPB was lower; variance analysis showed that there were significant differences between the two groups in serum levels of P-selectin trend. Serum levels of ET-1 immediately after CPB remains preoperative levels, the CPB after 12h two groups of ET-1 levels increased significantly, up to 48 hours after CPB remained significantly higher than the preoperative level; 12,24,48 h after CPB ET-1 water perfusion group average significantly lower than the control group, serum ET-1 level trends between the two groups were significantly different. Control group, serum MDA level significantly immediately after CPB increased to the CPB 12h after the return to the preoperative level below; perfusion group after CPB serum the MDA has remained at or below the level of preoperative serum MDA level trends exist between the two groups is significant differences. [Conclusion] ischemia - reperfusion important factor the immature lung CPB lung injury. CPB in pulmonary perfusion with hypothermic HTK solution can curb the neutrophil-mediated lung injury, effectively reducing the inflammatory response of the lung tissue to protect the pulmonary vascular endothelial cell function, reduce free radical oxidative damage, improve the tetralogy's quadruple sign correction surgery after children with pulmonary ventilation function and improve prognosis. The the immature lung protective role in the second part of pulmonary perfusion with hypothermic HTK solution correction surgery of congenital heart disease associated with pulmonary hypertension [Objective] To evaluate the cardiopulmonary bypass (CPB) in pulmonary perfusion with hypothermic HTK solution associated with severe pulmonary hypertension. The left-to-right shunt the immature lungs protective effect correction surgery of congenital heart disease. [Method] From July 2009 to December 2009, 24 cases of select continuous surgical treatment accompanied by severe pulmonary hypertension in children with congenital heart disease, including 13 males and 11 females;-month-old March-October an average of 6.7 ± 2.6 months; weight 4.5-8.7kg, an average of 6.7 ± 1.9kg. Preoperative pulmonary perfusion and control groups were randomly divided into to record general clinical data and detection, after oxygenation index (0I) and alveolar - arterial oxygen difference (AaDO2), serum malondialdehyde (MDA), serum interleukin-6 (IL-6), White mediated Su-8 (IL-8), White mediated Su-10 (IL-10), tumor necrosis factor α (of TNF-α), endothelial prime 1 (ET-1), of P-selectin and soluble cell adhesion molecule -1 (sICAM-1), and analyzed statistically. [Result] The control group after CPB oxygenation index significantly decreased until 48h after still lower than the preoperative perfusion group after CPB time point oxygenation index remained preoperative levels, there are significant differences between the two groups trends . Two groups after CPB the instant AaDO2 have increased, but the level of perfusion group rose significantly compared with the preoperative and significantly lower than the control group; I point in time the two groups AaDO2 than before surgery were no significant differences; between the two groups AaDO2 The trend was also no significant difference. Reperfusion group and a control group of serum IL-6 level immediately after CPB were significantly higher, but the perfusion group to restore earlier and faster, although to CPB after 48h two groups of IL-6 levels before surgery are no significant differences in comparison, but in the control group 12,24 h after IL-6 levels significantly compared with R group is high; serum IL-6 levels trend no significant differences between the two groups. Control group, serum IL-8 levels immediately after CPB significantly increased, but returned to preoperative levels to postoperative 12h reperfusion group at all time points after CPB has been in a similar low level and before CPB; between the two groups in serum The significant difference in the level of IL-8 trend. Two groups after CPB serum IL-10 levels were significantly increased, until 48h after recovery, but the immediate postoperative IL-10 levels perfusion group was significantly higher than that of the control group; serum IL-10 level trend was no significant difference between the two groups . Control group, serum TNF-α levels immediately after CPB significantly increased after 12h to CPB returned to preoperative levels, and perfusion group after CPB has been in a similar low level and before CPB; serum TNF-α levels between the two groups change trend there are significant differences. Control group, serum sICAM-1 levels in 24h after CPB compared with preoperative increased, and significantly higher than the infusion group, I point in time than before surgery, and the two groups were not significantly different between; analysis of variance between the two groups displayed serum sICAM-1 levels trend was no significant difference. Control group, serum P-selectin levels immediately after CPB than before CPB was significantly higher, but to CPB that is returned to preoperative levels 12h reperfusion group after surgery has been no higher than the CPB 24,48 h after surgery or significant before lower; analysis of variance showed significant differences between the two groups in serum levels of P-selectin trend. Serum levels of ET-1 immediately after CPB remains preoperative levels, the CPB after 12h two groups of ET-1 levels increased significantly until 48 hours after CPB remained significantly higher than the preoperative level, but between the two groups at each time point ET-1 levels were not significantly different; trend of serum ET-1 levels between the two groups and no significant difference. Control group, serum MDA levels immediately after CPB significantly increased to 24h after nearly preoperative levels; perfusion group after CPB the serum MDA has remained preoperative level, significant differences in serum MDA level trends exist between the two groups. [Conclusion] ischemia - reperfusion is an important factor in the immature lung CPB lung injury associated with severe pulmonary hypertension is more prone to pulmonary complications after surgery. CPB in pulmonary perfusion with hypothermic HTK solution can curb the neutrophil-mediated lung injury, effectively reducing the inflammatory response of the lung tissue to protect the pulmonary vascular endothelial cell function, reduce free radical oxidative damage and improve associated with severe pulmonary hypertension, congenital correction of postoperative ventilatory function in children with pulmonary heart disease and improve prognosis.

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