摘要
目的 探讨小剂量抑肽酶对体外循环（CPB）所致急性肺损伤的保护作用。方法 28例首次择期心脏瓣膜置换术患者随机分为抑肽酶组和对照组,各14例。于麻醉诱导前、CPB前、CPB结束后1h及24h测定TNF-α和IL-10血浆水平,于CPB前、CPB结束后10min、1h测定呼吸指数（RI）。结果 CPB结束后1h及24h,对照组TNF-α明显高于诱导前及相同时点抑肽酶组的水平（P<0.05）;CPB结束后1h,两组IL-10均明显增加,但抑肽酶组明显高于对照组（P<0.05）;CPB结束后10min及1h,对照组RI较基础值及抑肽酶组明显增高（P<0.05）。结论 小剂量抑肽酶具有抗炎及肺保护作用。
ve To evaluate the protective effect of low-dose aprotinin on lungs from acute injury induced by cardiopulmonary bypass(CPB).Methods Twenty-eight ASA II-III patients (13 male, 15 female) aged (40.39±8.51) years, weighing (56.79±7.61) kg scheduled for elective valve replacement, were divided into two groups of 14 each: control group and aprotinin group. Patients who had infectious disease or received glucocorticoid before operation were excluded. The mean duration of CPB was (127.93±52.96) min and the mean aortic cross-clamping time was (68.54±30.71) min.The patients were premedicated with intramuscular phenobarbital 0.1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0. 1-0.2mg·kg, fentanyl 10-20μg,kg-1 and intubation was facilitated with vecuronium 0.1-0.12 mg·kg-1. Radial artery and right internal jugular vein were cannulated for direct BP and CVP monitoring. Anesthesia was maintained with intermittent boluses of fentanyl and vecuronium supplemented with enflurane inhalation. The patients were mechanically ventilated. Tidal volume was maintained at 10-12 ml·kg , respiratory rate 12 bpm and I:E ratio 1:2.In aprotinin group 1 × 10~6KIU of aprotinin was added to the priming solution, 1 × 10~6 KIU aprotinin was infused after induction of anesthesia until thoracotomy and 2.5 × 105KIU.h-1 was infused from thoracotomy until the end of surgery. In control group aprotinin was replaced by same volume of lactated Ringer solution. Peripheral blood samples were taken before induction of anesthesia, before CPB and 1,24 h after termination of CPB, for determination of IL-10 and TNF-α. Respiratory index [P( A-a)DO2/PaO2] was calculated before CPB, 10 min and 60 min after CPB. Results There was no significant difference in age, weight, duration of operation CPB time and aortic cross-clamping time between the two groups. The TNF-α concentration was not significantly different before induction of anesthesia and CPB between the two groups. But at 1 and 24 h after CPB TNF-α level was significantly higher than the baseline value before anesthesia in control group and that in aprotinin group. The IL-10 concentration greatly increased at 1 h after CPB in both groups as compared with that before anesthesia, but was much higher in the aprotinin group than that in the control group. Respiratory index at 10 min and 60 min after CPB was higher than the baseline value in control group andthat in the aprotinin group (P<0.01).Conclusions Low-dose aprotinin does have anti-inflamatory and lung protective effect.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第1期13-16,共4页
Chinese Journal of Anesthesiology
