摘要
目的 探讨在缺血再灌注早期吸入七氟醚对体外循环心脏手术患者肺组织炎性反应的影响.方法 40例择期行瓣膜置换术的风湿性心脏病患者,按随机数字表法分为对照组和七氟醚组,每组20例.七氟醚组在阻断升主动脉前吸入2%七氟醚15 min,阻断升主动脉后继续经膜式氧合器吸入2%七氟醚15 min;开放升主动脉前15 min经膜式氧合器吸入2%七氟醚预充,开放升主动脉后持续吸入2%七氟醚15 min.对照组不吸入七氟醚,其他处理同七氟醚组.时点界定为：T0（麻醉后切皮前）、T1（体外循环开始前即刻）、T2（体外循环停机即刻）、T3（停机后2 h）、T4（停机后6 h）、T5（停机后24 h）.分别在T0、T2、T3、T5抽取桡动脉血测定可溶性细胞间黏附因子-1（sICAM-1）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-8.在T1、T2时点分别抽取肺动脉、肺静脉血进行血中性粒细胞计数并计算二者差值.分别在T0、T2、T3、T4、T5时间点进行动脉血气分析,并计算氧合指数（OI）、肺泡-动脉氧分压差[P（A-a）O2]、肺静态顺应性（Cst）.结果 组内比较：两组TNF-α、IL-8、sICAM-1浓度在T2、T3、T5时点较本组T0均明显升高（P〈0.05）.七氟醚组TNF-α、IL-8、sICAM-1水平在T2、T3时点明显低于对照组同时点（P〈0.05）.组内比较：两组T2时点肺动脉、肺静脉血中性粒细胞计数及其差值均较本组T1时点明显增加（P〈0.05）.组间比较：七氟醚组T2时点肺动脉、肺静脉血中性粒细胞计数及其差值明显低于对照组（P〈0.05）.组内比较：两组P（A-a）O2在T2、T3、T4、T5时点较本组T0均明显升高（P〈0.05）;两组OI在T2、T3、T4、T5时点较本组T0均明显降低（P〈0.05）;两组Cst在T2、T3、T4时点较本组T0均明显降低（P〈0.05）.组间比较：在T2、T3、T4时点七氟醚组P（A-a）O2明显低于对照组（P〈0.05）;在T2、T3、T4时点七氟醚组OI、Cst明显高于对照
Objective To evaluate the effects of inhalation sevoflurane in the early ischemia and reperfusion on pulmonary inflammatory response in patients undergoing cardiac surgery with extracorporeal circulation （ECC）. Methods Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into 2 groups （20 patients in each group）： control group and sevoflurane group. In sevoflurane group, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and also before and after the ascending aorta was opened. Paitents in control group didn′t inhale sevoflurane. Time was defined as the followings： after anesthesia and before skin incision （T0）, immediately before ECC （T1）, immediately after ECC （T2）, 2 h after ECC （T3）, 6 h after ECC （T4） and 24 h after ECC （T5）. At T0, T2, T3, T5, the radial artery blood was obtained to detect the levels of plasma tumor necrosis factor-α（TNF-α）, interleukin-8（IL-8） and soluble intercellular adhesion molecule-1（sICAM-1）. At T1, T2, the pulmonary artery and pulmonary vein blood was obtained to detect the neutrophil count and calculate the differences between the vein and artery. At T0, T2, T3, T4, T5, the arterial blood gas was detected and differences of alveoli-arterial oxygen pres [P（A- a）O2], oxygenation index （OI）, static compliance （Cst） were calculated. Results The levels of plasma TNF-α, IL-8 and sICAM-1 were higher at T2, T3, T5 than those at T0 in two groups （P〈0.05）. The levels of plasma TNF-α, IL-8 and sICAM-1 were decreased in sevoflurane group at T2 and T3, compared with those in control group （P〈0.05）. The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were higher at T2 than those at T0 in two groups （P〈0.05）. The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were decreased in sevoflurane group at T2 compared with th
作者
吕洁萍
田首元
聂丽霞
郝倩
周莉
Lyu Jieping Tian Shouyuan Nie Lixia Hao Qian Zhou Li.(Department of Anesthesiology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China)
出处
《中国医师进修杂志》
2017年第6期486-490,共5页
Chinese Journal of Postgraduates of Medicine
基金
山西省应用基础研究自然科学基金（201601D102068）
关键词
体外循环
七氟醚
炎性反应
Extracorporeal circulation
Sevoflurane
Inflammatory response
