肝素化膜肺和甲基强的松龙预处理对心肺转流后肺损伤的防治作用  

The effect of heparin-bonded membrane oxygenator and methylprednisolone on the acute lung injury after cardiopulmonary bypass

作　　者：杨改生[1] 姜桢[2] 胡克俭[3] 赵赟[3] 金翔华[2] 薛张纲[2] 蒋豪[2] 张晋东[1] 

机构地区：[1]中国人民解放军空军总医院麻醉科,北京市100036 [2]复旦大学附属中山医院麻醉科 [3]复旦大学附属中山医院心肺转流组

出　　处：《临床麻醉学杂志》2006年第7期490-492,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察肝素化膜肺和甲基强的松龙预处理对炎性细胞因子的影响和对心肺转流(CPB)后肺损伤的防治作用。方法30例择期行双瓣膜置换的病人,随机均分为三组:肝素化膜肺组(H组)、甲基强的松龙组(M组)和对照组(C组)。术中持续监测ECG、HR、SpO2、MAP、CVP、心输出量(CO);术前、CPB前、主动脉开放前、开放后0·5、1、2、6h采取动脉血测定细胞因子如肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的变化;术前、CPB前、主动脉开放后1·5、2、6h采血测定动脉血气,氧合指数(PaO2/FiO2),同期监测气道压并计算肺的顺应性。结果三组病人在主动脉开放前、开放后0·5、1、2、6h时TNF-α、IL-1β、IL-6均较术前显著升高(P<0·05,P<0·01)。主动脉开放前、开放后0·5、1、2、6h时M组TNF-α、IL-1β、IL-6均较C组显著降低(P<0·05,P<0·01);主动脉开放后0·5、1hH组TNF-α、IL-1β、IL-6较C组明显降低(P<0·05),且M组在开放后各时点TNF-α、IL-1β、IL-6较H组降低更明显(P<0·01)。三组开放后各时点较CPB前气道阻力轻度升高,但三组间差异无显著意义。主动脉开放后1·5、2、6h三组病人和术前相比PaO2/FiO2显著降低(P<0·05,P<0·01);与H组、C组相比,M组在主动脉开放后1·5、2、6h时PaO2/FiO2显著增加(P<0·01)。结论CPB可引起以炎性细胞因子升高为特征的全身性炎症反应,产生肺损伤;单纯肝素涂抹膜肺轻度降低细胞因子变化,但对肺功能无明显保护作用;小剂量甲基强的松龙(5mg/kg)可有效抑制细胞因子的升高,促进肺功能的恢复。Objective To study the effect of heparin-bonded membrane oxygenator and methylprednisolone on the acute lung injury after cardiopulmonary bypass. Methods Thirty adult patients undergoing elective dual valves replacement were randomly divided equally into three groups： heparinbonded membrane oxygenator （group H） 、 methylprednisolone group （group M） and control group （group C）. ECG,CVP,MAP,MPAP and airway pressure were monitored in all groups. Artery blood samples were taken after induction of anesthesia,before CPB,before release of aorto crossclamp,0.5, 1,2,6 h after release of the aortic crossclamp to measure the concentrations of TNF-α, IL-1β, IL-6 and blood gas analysis, and oxygenation index（PaO2/FiO2 ） were calculated. Results Plasma levels of all the cytokines increased significantly before aortic crossclamping and 0.5,1,2,6 h after release of the aortic crossclamp compared with baseline （P〈0.05,P〈0.01）. The levels of TNF-α, IL-1β,IL-6 in C group were significantly higher than that of group H（P〈0.05,P〈.0.01） and group M （P〈.0.01）, and the levels of cytokines were significantly higher in group H than that of group M. In all groups PaO2/FiO2decreased significantly at 1.5,2,6 h after release of the aortic crossclamp compared with baseline （P〈0.05,P〈0.01）. There was no significant difference between the group C and group H PaO2/FiO2, but group C and group H significantly lower in PaO2/FiO2 than that of group M（P〈 0.01）. The pulmonary compliance decreased and airway pressure increased in group H and group C, but no significant differences compare with baseline. Conclusion Heparirr-bonded membrane oxygenator and methylprednisone can significantly reduce the systemic inflammatory reaction caused by CPB. The effects of methylprednisone was more powerful than that of heparin-bonded membrane oxygenator.

关 键 词：心肺转流 细胞因子 急性肺损伤 甲基强的松龙 肝素涂抹膜肺 

分 类 号：R614[医药卫生—麻醉学]