摘要
目的:观察七氟烷预处理对心肺转流术(cardiopulmonary bypass,CPB)后早期肺损伤的影响及其机制。方法:择期CBP下行心脏瓣膜置换术的患者16例,随机分为对照组(C组)和七氟烷组(S组),每组8例。两组均采用静脉注射芬太尼、咪唑安定、维库溴铵维持麻醉,S组分别在CPB开始前吸入七氟烷达1.3最小肺泡浓度(MAC)后维持时间大于30min,洗脱15min,而C组只吸入纯氧。分别于麻醉诱导后10min(T1),上下腔静脉开放30min(T2)、180min(T3)采桡动脉血进行血气分析并计算肺泡动脉氧分压差(PA-aDO2)、氧合指数(OI)、呼吸指数(RI),测定血清中的肿瘤坏死因子-α(TNF-α)、P-选择素(P-selectin)浓度。关胸前每组取2例患者少量肺组织查缝隙连接蛋白CX43的表达及作肺组织病理学检查。结果:与T1时点比较,两组T2、T3时点TNF-α、P-selectin水平均明显升高(P<0.05),C组T3时点RI值明显增高(P<0.01);与C组比较,S组T2、T3时点TNF-α、P-selectin升高幅度较C组低(P<0.05),T3时点RI值S组低于C组(P<0.05)。肺CX43分布与着色两组差异无统计学意义。两组肺组织病理检查均可见肺泡结构破坏及渗出液,肺泡腔中性粒细胞及红细胞浸润,但C组明显比S组严重。结论:七氟烷预处理抑制TNF-α、P-selectin的释放,抑制CBP后肺炎性反应,对CPB后早期肺损伤具有一定的保护作用。
Objective：To observe effects of sevoflurane preconditioning against cardiopulmonary bypass （CPB）-induced early lung injury.Methods：Sixteen patients undergoing the cardiac valve replacement surgery were randomly divided into control Group （Group C,n=8） and the sevoflurane group （Group S,n=8）.During the operation,the midazolam,fentanyl,vecuronium bromide were mainline for maintenance of anesthesia. In Group S patients inhaled sevoflurane till the end-tidal concentration to 1.3 minimum alveolar concentration （MAC） before CPB,maintained no less than 30 min,then eluted for 15min.Meanwhile the other patients in Group C only inhaled pure oxygen,The blood samples were taken from arterial line in 10 min after induction（T1）,then the vena cava opened up after 30 min （T2） and 180 min（T3）.Furthermore the respiratory index （RI,PA-aDO2/PaO2） were calculated according to the blood-gas analysis. Finally the arterious blood samples were collected for determination of serum tumor necrosis factor-α（TNF-α）,P-selectin and malondialdehyde（MDA ）.Before the closure of the chest a bit of tissues of lungs coming from the 2 patients in each group were testing gap junction protein 43 （CX43） and undergoing a pathological studies examination.Results：The serum levels of TNF-α and P-selectin were significantly increased at T2-3 in two groups（P0.05）.RI were significantly higher at T3 in Group C（P0.01）; Compare with Group C,The TNF-α and P-selectin level were lower at T2,T3 in Group S （P0.05）; RI were significantly lower at T3 in Group S （P0.05）.There were no significant differences in distribution,coloration of lung gap junction CX43 expression in two group. Microscopic examination showed that there were obviously edema formation in alveolar spaces,alveolar structure was destroyed as well,then the severe neutrophil accumulation were both observed in the two groups,so did the red boold cell infiltration in two groups,but the changes were less severe in Group S.Conclusions：Sevoflurane preconditioning may attenuate the levels of the serum TNF-α,P-selectin,they could reduce lung inflammatory reaction. The sevoflurane pretconditioning affects the functional protection of lungs against the early injury of lungs which is induced by CPB as well.
出处
《中国临床医学》
2010年第2期171-174,共4页
Chinese Journal of Clinical Medicine
基金
贵州省科技厅基金资助项目(编号:E2008-23)
关键词
七氟烷
预处理
肺损伤
心肺转流术
Sevoflurane
Preconditioning
Lung injury
Cardiopulmonary bypass
