The Lung Protective Effect Of 5% Albumin Injection In The Operation Of Congenital Heart Disease

Objective: To observe the effect of 5% albumin injection and crystalloid fluid on Alveolar arterial oxygen difference in children with congenital heart disease.The protective effect of 5% albumin injection on children's lung was studied.The CPB animal model was established in rabbits.The effect of 5% albumin injection on the level of serum inflammatory factors was observed.The expression of 5% albumin injection on the signal pathway of HMGB1/TLR4/NF-?B was studied The protective mechanism of protein injection priming on lung injury of CPB was further observed,and the relationship between the use of albumin and the expression of inflammatory factors and related signal pathway proteins was further observed.Method: From February 2017 to February 2019,the children with congenital heart disease who underwent open heart surgery in pediatric surgery of Tianjin chest hospital were divided into two groups according to the different intraoperative fluid use plan: the group using 5% albumin injection(observation group)and the group using crystal solution(control group).The general data of the children were collected and recorded.The perioperative data were recorded.collection of perioperative blood gas examination data of children;mechanical ventilation time,ICU stay time and total hospitalization time were recorded.The rabbits were divided into two groups: the observation group(5% albumin injection pre filled CPB pipeline group)and the control group(crystal solution pre filled CPB pipeline group).The inflammatory factors were measured.The pathological sections of the lung tissue and the ratio of wet weight to dry weight of the lung were observed.The relative expression of HMGB1 and TLR4 mRNA in lung tissue of 5%albumin injection group and crystal solution group was detected by real time PCR,and the relative expression of IL-1?,IL-6,IL-10 and TNF-?mRNA in lung tissue was detected by real time PCR.Result: The time of mechanical ventilation in the observation group was shorter than that in the control group(15.1±1.6 vs 20.1±1.8),the difference was statistically significant(P < 0.01).The amount of transfusion in the observation group was lowerthan that in the control group(219.2±78.8 vs 361.8±50.3),the difference was statistically significant(P<0.05);the amount of erythrocytes used in the observation group was lower than that in the control group(0.7±0.2 vs 1.2±0.3),the difference was statistically significant(P < 0.05).The pathological results of lung injury showed that the lung tissue of the two groups had congestion,edema and inflammatory cell infiltration in different degrees,but compared with the rabbits in the crystal solution group,the congestion,edema and inflammatory cell infiltration of the lung tissue of the albumin group were relatively light.The serum levels of IL-1,IL-6,IL-10 and TNF-? in the two groups were significantly higher than those in the control group(P < 0.05).he results showed that the expression of IL-1?,IL-6 and TNF-?mRNA in the lung tissue of the 5% albumin injection group was significantly lower than that of the crystal solution group,while the expression of IL-10 was not statistically different,and the expression of HMGB 1and TLR4 mRNA in the lung tissue was significantly lower.Western blot was used to detect the expression of p-nf-?B and NF-?B in the lung tissue of the two groups of rabbits.It was found that the phosphorylation level of NF-?B in the lung tissue of the5% albumin injection group was significantly lower than that of the crystal solution group.Conclusion: 5% albumin injection can significantly improve the A-a DO2 value,reduce the use of red blood cells and shorten the time of mechanical ventilation,but there is no significant change in the duration of stay and total hospital stay in ICU.The application of 5% albumin injection as the precharge of CPB can reduce the levels of IL-1,IL-6 and IL-10 in plasma during CPB,reduce the degree of pulmonary interstitial edema and inflammatory reaction,and play a certain role in lung protection.By inhibiting HMGB1 / TLR4 / NF-?B signaling pathway and reducing the release of inflammatory factors,5% albumin injection can reduce the inflammatory response of lung tissue and play a protective role in lung injury of CPB.