奥曲肽对心脏瓣膜置换术患者Clara细胞分泌蛋白和肺功能的影响  

Effects of octreotide on Clara cell secretory protein and lung function in patients undergoing cardiac valve replacement

作　　者：刘流[1] 李李[1] 周海洋[1] 

机构地区：[1]中南大学湘雅二医院麻醉科,湖南长沙410011

出　　处：《中国新药与临床杂志》2010年第9期655-659,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：湖南省自然科学基金(07JJ3143)

摘　　要：目的观察奥曲肽对心脏瓣膜置换术患者Clara细胞分泌蛋白(CCSP)和肺功能的影响。方法择期心脏瓣膜置换术患者40例,随机分为2组,每组20例。奥曲肽组在麻醉诱导后静脉注射奥曲肽0.1 mg,然后0.5 mg溶于60 mL氯化钠注射液中泵注至体外循环(CPB)结束,对照组予等容量氯化钠注射液泵注。分别于转流前(T0)、停CPB后观察患者平均气道压(Paw),氧合指数(OI),呼吸指数(RI),静、动态肺顺应性(Cst、Cdyn),血清和肺泡灌洗液(BLAF)CCSP含量,血清TNF-α、IL-6、IL-8因子及BLAF中白细胞计数和中性粒细胞的比例。结果与T0比较,停CPB后2组患者Paw,RI,血清TNF-α、IL-6、IL-8以及BALF中白细胞计数和中性粒细胞比例均升高,血清和BLAF中CCSP含量下降。对照组OI、Cst、Cdyn明显下降(P<0.05),奥曲肽组无明显变化。CPB停1 h后2组同时值比较,奥曲肽组Paw、RI、TNF-α、IL-6及BALF中白细胞计数和中性粒细胞比例均低于对照组,OI、Cst、Cdyn高于对照组,均有显著差异(P<0.05)。停CPB后6 h和24 h,奥曲肽组血清和BLAF中CCSP高于对照组,血清IL-8低于对照组(P<0.05)。结论奥曲肽可明显减轻CPB炎症反应所致肺损伤,有效改善心脏瓣膜置换术患者肺功能。其机制可能与促进CCSP的合成和分泌,抑制CPB炎症反应有关。AIM To investigate the effects of octreotide on Clara cell secretory protein（CCSP） and lung function in patients undergoing cardiac valve replacement.METHODS Forty scheduled patients undergoing cardiac valve replacement were randomly divided into two groups： octreotide group and control group.After anesthesia induction,0.1 mg octreotide was injected intravenously and 0.5 mg.60 mL-1 octreotide was given intravenously until the end of cardio-pulmonary bypass（CPB） in the octreotide group.The same volume of sodium chloride injection was given in the control group.Blood samples were taken before CPB（T0） and after CPB stopping for the determination of TNF-α,CCSP,IL-6 and IL-8.The pressure of airway（Paw）,oxygenation index（OI）,respiratory index（RI）,static compliance（Cst） and dynamic compliance（Cdyn） of lung and CCSP in bronchoalveolar lavage fluid（BALF） were also measured.RESULTS The levels of TNF-α,IL-6,IL-8,WBC and neutrophil percentage in BALF,Paw and RI after CPB were increased compared with T0 in both groups,while CCSP in plasma and BALF decreased.The OI,Cst and Cdyn were significantly decreased in the control group（P 0.05）,while no changes in the octreotide group.The levels of Paw,RI,TNF-α,IL-6,WBC and neutrophils percentage in BALF in the octreotide group were significantly lower than those in the control group（P 0.05） at the same point 1 h after CPB,while OI,Cst and Cdyn were higher（P 0.05）.The CCSP in plasma and BALF in the octreotide group were significantly higher than those in the control group（P 0.05） 6 h and 24 h after CPB,while the level of IL-8 was lower（P 0.05）.CONCLUSION Octreotide could alleviate the lung injury induced by CPB.The inhibition of inflammatory response and increase in CCSP may explain the mechanisms involved.

关 键 词：奥曲肽 呼吸功能实验 心脏瓣膜 瓣膜置换术 CLARA细胞分泌蛋白 

分 类 号：R977.1[医药卫生—药品]