七氟醚后处理对心脏瓣膜置换术患者体外循环后肺功能的影响  

Effects of sevoflurane postconditioning on lung function after cardiopulmonary bypass in patients undergoing cardiac valve replacement

作　　者：贺克强[1] 王瑞婷[1] 潘建辉[1] 柴小青[1] 康芳[1] 程光存[2] 凡小庆[1] 王德龙[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001 [2]安徽医科大学附属省立医院心脏外科,合肥市230001

出　　处：《中华麻醉学杂志》2013年第8期975-979,共5页Chinese Journal of Anesthesiology

基　　金：安徽省卫生厅医学科研课题资助项目（09A065）

摘　　要：目的 评价七氟醚后处理对心脏瓣膜置换术患者体外循环（CPB）后肺功能的影响.方法 择期行CPB下心脏瓣膜置换术患者30例,年龄33 ～ 64岁,体重47 ～ 81kg,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级.采用随机数字表法,将患者分为2组（n=15）：对照组（C组）和七氟醚后处理组（S组）.S组于主动脉开放前通过CPB机预充2％七氟醚,主动脉开放后继续洗入2％七氟醚15 min.分别于麻醉前（T1）、劈开胸骨后即刻（T2）、停止CPB后30 min（T3）、术后6h（T4）、12h（T5）和24h（T6）时采集桡动脉血样,行血气分析,记录PaO2、SaO2,计算氧合指数（OI）、肺泡动脉氧分压差（DA-aO2）；计算动态肺顺应性（Cdyn）和静态肺顺应性（Cstat）.分别于T1、T3、T4、T6时采集桡动脉血样,采用ELISA法测定血清白细胞介素-17A（IL-17A）、中性粒细胞弹性蛋白酶（NE）和基质金属蛋白酶-9（MMP-9）的浓度.记录术后机械通气时间、气管导管拔除后24h内呼吸困难、再次气管插管以及肺部哕音的发生情况.结果 与C组比较,S组T4-T6时OI升高,T5、T6时DA-aO2降低,T4、T5时PaO2升高,T3、T6时SaO2升高,T3、T4时Cdyn升高,T4时Cstat升高,T3、T4和T6时血清IL-17A、NE和MMP-9浓度降低,机械通气时间缩短,肺部哕音发生率降低（P＜0.05）,呼吸困难发生率差异无统计学意义（P＞0.05）,2组均未再次气管插管.结论 七氟醚后处理可改善心脏瓣膜置换术患者CPB后肺功能,机制可能与抑制炎性反应有关.Objective To evaluate the effects of sevoflurane postconditioning on lung function after cardiopulmonary bypass （CPB） in patients undergoing cardiac valve replacement.Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 33-64 yr,weighing 47-81kg,scheduled for cardiac valve replacement with CPB,were equally and randomly divided into control group （group C） or sevoflurane postconditioning group （group S）.Anesthesia was induced with iv injection of midazolam,etomidate,fentanyl and rocuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam,fentanyl and pipecuronium.In group S,2％ sevoflurane was washed into the membrane oxygenator at 2 min before aortic unclamping and continuously washed into the membrane oxygenator for 15 min after aortic unclamping.Before anesthesia （T1）,immediately after sternum splitting （T2）,at 30 min after termination of CPB （T3）,and at 6,12 and 24h after operation （T4-6）,blood samples were taken from the radial artery for blood gas analysis and PaO2 and SaO2 were recorded.Oxygen index （OI）,alveolar-arterial oxygen tension difference （DA-aO2）,dynamic pulmonary compliance （Cdyn） and static pulmonary compliance （Cstat） were calculated.Arterial blood samples were collected at T1,T3,T4 and T6 for determination of serum concentrations of IL-17A,neutrophil elastase （NE） and matrix metalloproteinase-9 （MMP-9）.The time of mechanical ventilation after surgery and development of dyspnea,re-intubation and pulmonary rales were recorded.Results Compared with group C,OI at T4T6,PaO2 at T4 and T5,SaO2 at T3 and T6,Cdyn at T3 and T4 and Cstat at T4 were significantly increased,DAaO2 at T5 and T6,serum concentrations of IL-17A,NE and MMP-9 at T3,T4 and T6,and the incidence of pulmonary rales were decreased,and the time of mechanical ventilation was shortened （P ＜ 0.05）,and no significant change was found in the incidence of dyspnea in group S （P ＞ 0.05�

关 键 词：麻醉药 吸入 呼吸功能试验 心肺转流术 心脏瓣膜假体植入 

分 类 号：R614[医药卫生—麻醉学]