参麦注射液对体外循环后肺损伤保护作用的临床研究

作者	单位
陈菲菲	温州医学院附属第一医院
林丽娜	温州医学院附属第一医院
缪剑霞	温州医学院附属第一医院
胡明伦	温州医学院附属第一医院

摘要点击次数: 1314

全文下载次数: 2

中文摘要:

目的观察参麦注射液对体外循环(CPB)所致急性肺损伤(ALI)的保护作用。方法选择30例CPB下首次行心脏瓣膜置换术患者,随机分为试验组和对照组,每组15例。两组患者常规麻醉后在体外循环下行心脏瓣膜置换术,试验组于麻醉诱导插管后CPB转机前将参麦注射液0.6 mL/kg加入250 mL生理盐水静脉滴注完毕,对照组在同一时间予生理盐水250 mL静脉滴注。分别于麻醉诱导前、CPB停机后0.5、2、6、24 h,取桡动脉血行血气分析,记录氧分压(PaO2)、二氧化碳分压(PaCO2)、吸入氧浓度(FiO2),计算肺泡-动脉血氧分压差[P(A-a)DO2]以及呼吸指数(RI),并留取血清测定可溶性细胞间黏附分子-1(soluble intercellular adhension molelue-1,sICAM-1)、血内皮素-1(endothelin-1,ET-1)和一氧化氮(NO)浓度。结果两组术前各项指标比较,差异无统计学意义(P>0.05),随着主动脉开放和CPB停机后时间的延长,P(A-a)DO2、RI显著升高,并于停机后2 h达高峰,试验组停机后0.5～24 h升高幅度明显低于对照组(P<0.05或P<0.01);两组各时点P(A-a)DO2与本组麻醉诱导前比较,差异有统计学意义(P<0.01)。两组停机后2～24 h RI与本组麻醉诱导前比较,差异有统计学意义(P<0.05或P<0.01)。两组sICAM-1浓度CPB后逐渐升高,停机后2 h达到高峰,停机后0.5～6 h明显高于术前(P<0.05或P<0.01);两组ET-1浓度均明显高于术前(P<0.05或P<0.01),而停机后0.5～2 h试验组升高的幅度低于对照组(P<0.01);血NO浓度在CPB后明显下降,CPB停机后0.5～24 h均明显低于术前(均P<0.01),但试验组下降幅度明显小于对照组(P<0.05或P<0.01)。结论参麦注射液通过抑制炎性细胞与血管内皮细胞黏附,对抗脂质过氧化,改善CPB后肺换气和氧合功能,减轻CPB后急性肺损伤。

英文摘要:

Objective To observe the protective effect of Shenmai Injection(SMI) on acute lung injury(ALI) induced by cardiac pulmonary bypass(CPB).Methods Thirty patients,scheduled to receive cardiac valve replacement by CPB for the first time,were equally randomized into 2 groups,the treated group and the control group.Cardiac valve replacement was performed under extracorporeal circulation after general anaesthesia.SMI 0.6 mL/kg was given to the treated group by adding in 250 mL physiological saline for intravenous dripping at the time between intubation under anaesthesia and CPB,while 250 mL physiological saline was given to the control group alone.Blood-gas analysis was performed with blood withdrawal from the radial artery to record PaO2,PaCO2,fraction of inspired oxygen(FiO2),by them the alveolar-arterial difference of partial oxygen pressure [P(A-a)DO2] was calculated,and the respiratory index(RI),the blood concentrations of soluble intercellular adhesion molelue-1(sICAM-1),endothelin-1(ET-1) and nitric oxide(NO) were measured at various time points,i.e.before anesthesia induction,0.5 h,2 h,6 h and 24 h after ending CPB.Results All indices were not significantly different between the two groups before operation(P>0.05).After CPB,P(A-a) DO2 and RI were gradually elevated and reached the peak at 2 h after ending CPB,the increment in the treated group was lower than that in the control group(P<0.05 or P<0.01).Compared with the P(A-a) DO2 before anesthesia induction,P(A-a)DO2 at 0.5-24 h was statistically different(P<0.05 or P<0.01).Compared with the RI before anesthesia induction,RI at 2-24 h was statistically different(P<0.05 or P<0.01).Blood concentrations of sICAM-1 gradually raised after CPB,and reached the peak at 2 h after ending CPB,showed a higher level at 0.5-6 h after ending CPB as compared with that before anesthesia induction(P<0.05 or P<0.01).Blood ET-1 showed a figure of increasing as sICAM did(P<0.05 or P<0.01),and with a lower degree at 0.5-2 h after ending CPB in the treated group(P<0.01).Blood NO obviously reduced after CPB,it was lower at 0.5-24 h after ending CPB than at that before anesthesia induction(P<0.01),and the decrement was lesser in the treated group(P<0.05 or P<0.01).Conclusion SMI can attenuate the acute lung injury after CPB by way of inhibiting vascular endothelial cell adhesion with inflammatory cells,antagonizing lipid peroxidation,and improving the ventilation and oxygenation function of lung.

关闭