远隔肢体缺血预处理对腹主动脉瘤手术病人肺损伤的影响  

Effects of remote limb ischemic preconditioning on lung injury in patients undergoing abdominal aortic aneurysm repair

作　　者：李偲[1] 李云胜[1] 刘家欣[1] 邬艳[1] 温仕宏[1] 周军[1] 许森[1] 刘克玄[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广州市510080

出　　处：《中华麻醉学杂志》2012年第3期269-273,共5页Chinese Journal of Anesthesiology

基　　金：基金项目：广东省卫生厅基金（B201080）

摘　　要：目的评价远隔肢体缺血预处理对腹主动脉瘤手术病人肺损伤的影响。方法择期行肾下型腹主动脉瘤切除人工血管置换术病人62例，性别不限，年龄54～72岁，体重指数21～36kg／m2，ASA分级Ⅱ或Ⅲ级。采用随机数字表法，将病人随机分为2组（n=31）：对照组（c组）和远隔肢体缺血预处理组（RLIP组）。RLIP组在麻醉诱导后手术前将左上肢用袖带加压至200mmHg5min后袖带放气5min，重复2次。分别于气管插管后10min（To）、主动脉开放后30min（rrJ）、术后4h（T2）、8h（T3）、12h（T4）、24h（T5）时采集动脉和静脉的血样，进行动脉血气分析，计算肺泡．动脉血氧分压差（PA-a O2）和呼吸指数（RI），并测定静脉血血清白细胞介素-6（IL-6）、肿瘤坏死因子-a（TNF-a）浓度、血浆超氧化物歧化酶（SOD）活性和丙二醛（MDA）浓度。分别于上述时点记录气道峰压（P peak）、气道平台压（R pla1）和呼气末正压（PEEP），以计算肺动态顺应性（Cs）和肺静态顺应性（Cd）。记录术后低氧血症发生情况、拔除气管导管时间和ICU停留时间。结果与C组比较，RLIP组P A-a、RI和血IL-6、TNF—a和MDA的浓度降低，Cs、Cd和血SOD活性升高，术后低氧血症发生率降低，ICU停留时间和拔除气管导管时间缩短（P〈0．05）。结论远隔肢体缺血预处理可减轻腹主动脉瘤手术病人肺损伤，其机制与抑制炎性反应及脂质过氧化反应有关。Objective To investigate the effects of remote limb ischemic preconditioning （RLIP） on the lung injury in patients undergoing abdominal aortic aneurysm repair. Methods Sixty-two ASA II or III patients of both sexes, aged 54-72 yr, with body mass index 21-36 kg/m2 , undergoing elective abdominal aortic aneurysm repair, were randomly divided to 2 groups （ n = 31 each） ： control group （group C） and RLIP group. RLIP consisted of two 5-min cycles of left upper limb ischemia induced by a blood pressure cuff placed on the left upper arm and inflated to 200 mm Hg, with an intervening 5 min of reperfusion, during which time the cuff was deflated. RLIP was performed after anesthesia induction and before the start of surgery. Arterial and venous blood samples were taken at 10 min after intubation （T0）, and 30 min and 4, 8, 12 and 24 h after aortic unclamping （T1-5 ） for blood gas analysis and determination of the concentrations of serum interleukin （IL）-6, tumor necrosis factor （TNF）-a, and plasma malondialdehydc （MDA） and superoxide dismutasc （SOD） activity. The alveolar-arterial oxygen pressure difference （PA-a O2 ） and respiratory index （RI） were calculated. The peak airway pressure （Ppark）, plat airway pressure （Pplat） and positive end expiratory pressure （PEEP） were recorded at the same time points mentioned above to calculate dynamic lung compliance （Cd） and static lung compliance （Cs）. The incidence of hypoxemia, extubation time and duration of stay in intensive care unit （ICU） were also recorded. Results Compared with group C, PA-aO2, RI and the concentration of IL-6 were significantly decreased at T3-5 , Cs, Cd and SOD activity were significantly increased at T2_5, and the concentrations of TNF-a and MDA were significantly decreased at T2.5 in group RLIP （ P 〈 0.05）. Compared with group C, the incidence of hypoxemia was significantly decreased, and extubation time and duration of stay in ICU were significantly shortened in group RLIP �

关 键 词：上肢 缺血预处理 呼吸窘迫综合征 成人 主动脉瘤 腹 

分 类 号：R654.3[医药卫生—外科学]