七氟烷预处理对心肺转流术后肺氧化应激的影响  

Effects of sevoflurane preconditioning against cardiopulmonary bypass-induced oxidative stress response of lungs

作　　者：钟毅[1] 高鸿[1] 欧炜[1] 李红[2] 

机构地区：[1]贵阳医学院附属医院麻醉科,550004 [2]贵阳医学院组织胚胎学教研室

出　　处：《贵州医药》2010年第2期99-102,共4页Guizhou Medical Journal

基　　金：贵州省科技厅项目(E2008-23)

摘　　要：目的观察七氟烷预处理对心肺转流术(cardiopul monary bypass,CBP)后肺氧化应激的影响。方法择期CBP下行心脏瓣膜置换术的病人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开始前吸入七氟烷呼出气浓度达1.3 MAC后维持时间大于30 min,洗脱15 min,而C组只吸入纯氧,主动脉开放后不再使用七氟烷。分别于麻醉诱导后10 min(T1),上下腔静脉开放30 min(T2),开放180 min(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),测定血清中的丙二醛(MDA)浓度及超氧化物歧化酶(SOD)、髓过氧化物酶(MPO)活性。关胸前每组随机取2例病人少量肺组织行病理学检查。结果与T1时点比较,两组T2～3时点MDA、SOD水平均升高(P<0.05或P<0.01),两组MPO水平T2时点较T1明显增高(P<0.05),C组RI值T3时点较T1明显增高(P<0.01);与C组比较,S组T2,T3时点MDA升高幅度较C组低(P<0.01),T3时点RI值S组低于C组(P<0.05)。肺组织病理检查两组均可见肺泡间隔增宽水肿及肺泡结构破坏,肺泡腔PMNs及红细胞浸润,但C组比S组严重。结论七氟烷预处理抑制CBP后肺组织氧化应激反应,在一定程度上改善肺功能,对CBP后早期肺损伤具有一定的保护作用。Objective To observel effects of sevoflurane preconditioning against cardiopulmonary hypass （CBP）-induced oxidative stress response of lungs. Methods 16 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. Midazolam, fentanyl, veeuronium were mainline for maintenance of anesthesia. In group S patients inhaled sevoflurane till the end-tidal concentration to 1.3 MAC before CBP, maintained no less than 30 min, then eluted for 15 min. Meanwhile the other patients in group C only inhale pure oxygen. The blood samples were taken from arterial line in 10 rain after induction（TL）, after30 min （T2） and 180 min（T3）,aftervenacavaopened. Furthermore therespiratory index （RI, PA-aDO2/PaO2 ） were calculated according to the blood-gas analysis. Serum ma londialdehyde （MDA）, superoxide dismutase （SOD） and myeloperoxidase （MPO） were measur before fore chest closure a bit of tissues of lungs coming from the 2 patients in each group were operated pathological studies. Results Compared with T1 .Serum MDA, SOD were significantly higher at T2-3 in two groups（P〈0. 05 ）, also MPO were significantly higher at T2 （ P〈 0. 05 ）, RI were significantly higher at T3 in group C （ P〈0.01 ）. Compared with C group. The MDA level were lower at T2 , T3, （ P 〈0.05 ）and RI were significantly lower at T3 in group S（P〈0. 05）. 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 blood cell infihration in two groups, but the changes were less severe in group S. Conclusion The sevoflurane preconditioning may attenuate CBP-induced the oxidative stress response of lungs. The sevoflurane preconditioning affects the functional protection of lungs against the early injury of lungs which is induced

关 键 词：七氟烷 心肺转流术 预处理 氧化应激 

分 类 号：R614.2[医药卫生—麻醉学]