肺动脉灌注在体外循环中对磷酯酶A2的影响  

Effect of pulmonary artery perfusion on Phospholipase A2 during cardiopulmonary bypass

作　　者：陈聪[1] 曹民娟[1] 李伦明[1] 马丽芳[1] 闵振兴[1] 周新明[1] 

机构地区：[1]江门市中心医院麻醉科,广东省529070

出　　处：《中国心血管病研究》2010年第5期368-371,共4页Chinese Journal of Cardiovascular Research

基　　金：2009年江门市第一批科技计划项目（39）

摘　　要：目的 观察低温肺保护液肺动脉灌注在体外循环（CPB）心脏直视手术中对血氧合指数、肺静态顺应性及磷酯酶A2（PLA2）的影响,探讨肺动脉灌注对减轻肺损伤的生物学机制.方法 选择30例二尖瓣置换术患者,随机分为对照组和肺保护组,每组15例.肺保护组在体外循环中一次性从肺动脉灌注低温肺保护液,对照组未行肺动脉灌注.分别于麻醉诱导前（T1）、阻断升主动脉30 min（T2）、体外循环结束（T3）、手术结束（T4）和术后6 h（T5）各时间点取桡动脉血标本,动态检测两组患者各时间点的磷脂酶A2;在T1、T3、T4、T5对比观察血氧合指数、肺静态顺应性.结果 两组资料差异无统计学意义.CPB开始后,两组的PLA2进行性增高,手术结束时达到最高,后逐渐下降,但仍高于麻醉诱导前,对照组增高更显著[肺保护组T2、T3、T4、T5分别为（68.4±15.2）mg/ml、（86.9±25.6）mg/ml、（132.6±37.2）mg/ml、（96.53±6.1）mg/ml;对照组分别为（88.5±13.3）mg/ml、（107.3±25.6）mg/ml、（157.6±35.7）mg/ml、（113.6±39.5）mg/ml].肺保护组T3、T4、T5氧合指数分别为368±41、338±35、325±65,高于对照组（327±31、309±29、299±63）;肺保护组T3、T4、T5肺静态顺应性分别为（28.3±2.9）ml/cm H2O、（25.1±2.8）ml/cm H2O、（22.5±3.8）ml/cm H2O,高于对照组[（25.1±3.2）ml/cm H2O、（21.6±2.4）ml/cm H2O、（19.3±4.2）ml/cm H2O].结论 肺动脉灌注低温肺保护液不仅可以改善氧合,同时抑制磷酯酶A2的释放,减轻肺损伤,改善术后肺功能.Objective To observe the effects of pulmonary artery perfusion with hypothermic protective solution on the blood oxygenation index （OI）,lung static compliance （Cstat） and phospholipase A2 in eardiopulmonary bypass patients, and investigate the biological mechanism of protective pulmonary artery perfusion in reliev- ing lung injury. Methods Thirty patients undergoing mitral valve replacement were randomly divided into the control group （n= 15 ） and the lung perfusion group （n= 15 ）. The patients in the control group were performed routine techniques, and in the protective group the pulmonary artery were infused with 4 protective solutions during CPB. Blood samples were drawn from radial artery before induction, at the end of CPB and at 0, 6 h after the surgery. Phospholipase A2 was measured by ELISA perioperatively in both group. Oxygenation index （OI）,lung static com- pliance （Cstat） were recorded. Results After CPB, the levels of PLA2 inereased compared with the T1 in both group. The plasma level of PLA2 in the protective group was significantly lower than the control group. The OI and Cstat were higher after surgery in the lung perfusion group than those in the control group. Conclusion Perfusion with hypothermic protective solution to pulmonary artery during CPB can not only improve oxygen index and lung static compliance, but also inhibit the releases of PLA2 and reduce lung injury and improve pulmonary function.

关 键 词：体外循环 肺动脉灌注 磷酯酶A2 

分 类 号：R654.2[医药卫生—外科学] R614.25[医药卫生—临床医学]