Protective effects of desflurane and NO on the lung during cardiac surgery under CPB in children with congenital heart disease and pulmonary hypertension
- VernacularTitle:体外循环下心脏矫治术中地氟醚-NO对先心病合并肺动脉高压患儿肺的保护作用
- Author:
Ying SUN
;
Yu CHEN
;
Hong ZHOU
- Publication Type:Journal Article
- Keywords:
Child;
Heart defects, congenital;
Hypertension,pulmonary;
Cardiopulmonary bypass;
Nitric oxide;
Desflurane
- From:
Chinese Journal of Anesthesiology
1995;0(02):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of desflurane and/or nitric oxide (NO) on the lung injury induced by ischemia-reperfusion ( I/R) during cardiopulmonary bypass (CPB) in children with pulmonary hypertension secondary to congenital heart disease (CHD) .Methods Forty children with CHD and pulmonary hypertension (24 male, 16 female) aged 0.6-3.7 yrs weighing 7.1-11.9 kg undergoing cardiac surgery under CPB were randomly divided into 4 groups ( n = 10 each): group control; group DES; group NO and group DES + NO. The patients were premedicated with oral midazolam 0.5 mg?kg-1. Anesthesia was induced and maintained with fentanyl and vecuronium. Radial artery was cannulated for MAP monitoring and blood sampling. Pulmonary catheter was placed under direct vision after chest was opened. The patients received inhalation of desflurane (1-1.3 MAC) (group DES)/NO (10-20 ppm) (group NO) /DES + NO (group DES + NO) immediately after pulmonary catheterization until the start of CPB. MAP, PAP, peak airway pressure (Ppeak) and compliance of respiratory system (Crs) were recorded at 5 min after induction (T0 ), 5 min before CPB (T1 ), 5 min after start of CPB (T2) and at the end of surgery (T3) . Blood samples were taken at T0 and T3 for determination of methemoglobin (Met-Hb), soluble intercellular adhesion molecule-1 (sICAM-1), XOD and MDA.Results The four groups were comparable with respect to age, M/F ratio, body weight, duration of CPB and type of operation performed. MAP was significantly decreased after inhalation of desflurane alone or desflurane + NO before CPB ( at T1) as compared to the baseline value at T0; while PAP was significantly decreased after inhalation of NO alone or NO+ desflurane before CPB (at T1) as compared to the baseline value. Ppeak was significantly lower while Crs was significantly higher at end of surgery (T3) in group NO and NO + desflurane than in control group. Blood sICAM-1 and MDA concentrations and XOD activity were significantly lower at the end of surgery (T3 ) in group DES, NO and DES + NO than in control group. Met-Hb was significantly increased at the end of surgery (T2) as compared to the baseline (T0) in group NO and DES + NO but was still within normal range. Conclusion Inhalation of desflurane and/or NO can ameliorate the lung injury during CPB in children with pulmonary hypertension secondary to CHD, in addition to inhibit the pulmonary hypertension.
