摘要
目的 :观察心肺分流术 (CPB)后促炎因子和静止呼吸顺应性 (Cs)的变化 ,并探讨CPB后乌司他丁对肺功能的保护作用。 方法 :选择 30例接受CPB手术的患者 ,随机分为乌司他丁组 (U组 )和对照组 (C组 ) ,分别于麻醉后CPB前 (T1)、主动脉阻断 30min(T2 )、主动脉开放后 6 0min(T3 )、12 0min(T4)、180min(T5)各时间点 ,检测肿瘤坏死因子α(TNF α)、白细胞介素 6 (IL 6 )、IL 8及丙二醛 (MDA) ;同时计算Cs和动态肺顺应性 (Cd)及呼吸指数 (RI)。 结果 :CPB后 ,各时间点两组患者的TNF α、IL 6、IL 8及MDA较T1差异有显著性意义 (P <0 .0 1) ,与C组比较 ,U组CPB后各时间点上述各指标水平明显下降 (P <0 .0 5 ) ;C组T3 、T4、T5的Cs和Cd较T1有明显下降 ,与U组相应时间点比较亦有明显降低 (P <0 .0 5 ) ;C组T3 、T4、T5的RI明显高于U组 (P <0 .0 5 ) ,U组RI体外循环前后差异无显著性意义。 结论 :①CPB后患者外周血中TNF α、IL 6、IL 8及MDA均明显增加 ;②CPB能引起肺炎性损伤 ,病理生理改变主要表现在RI增加 ,肺顺应性下降 ;③乌司他丁能降低CPB后促炎细胞因子TNF α、IL 6、IL 8及氧自由基MDA的水平 ,可抑制CPB后RI的增加及肺顺应性的下降。
Objective:To observe the changes of the cytokines and oxidative free radical, respiratory index and lung compliance during open heart surgery under cardiopulmonary bypass(CPB), and to investigate the protective effect of ulinastatin on pulmonary function simutaneously. Methods: Thirty patients undergoing elective valvular replacement were prospectively randomized into two groups: group U(n=15) with ulinastatin and group C(n=15)with physiological saline. The tumor necrosis factor-a (TNF-α)、interleukin-6(IL-6)、interleukin-8(IL-8)and Malonaldehyde Acetal (MDA) were assessed before CPB (T 1), 30 min following aortic clamping(T 2), 1hour(T 3), 2hours(T 4) and 3hours(T 5) reperfusion respectively. While pulmonary thoracic compliance (Cs) and dynamic compliance (Cd) were measured at T 1, T 3,T 4, T 5. Respiratory indexes (RI)were calculated at the same time. Results: There were no differences in the values of TNF-α, IL-6, IL-8, MDA, Cs, Cd and RI at T 1(base value) between the two groups (P>0.05). After CPB, the levels in both groups increased significantly as compared with T 1(P<0.01). The levels in the group U were lower significantly (P<0.05) at the time of T 2,T 3,T 4 and T 5 than those in control group. There was a significant (P<0.01) decrease of C s and C d at T 3,T 4,T 5 in control group as compared with base values (T 1) and the values of the group U respectively(P<0.05). The RI of the control group at T 3,T 4,T 5 were higher than both the base values and the values of group U respectively(P<0.05). Conclusion: CPB induces lung inflammatory injury,the pathophysiological changes lead to the increase of RI and the decrease of lung compliance. Ulinastatin could protect the lung injury from CPB by inhibiting the lung inflammatory injury.
出处
《医学研究生学报》
CAS
2004年第6期519-521,524,共4页
Journal of Medical Postgraduates
关键词
乌司他丁
肺损伤
心肺分流术
肺功能保护
Ulinastatin
Lung injury
Cardiopulmonary bypass
Lung function protection
