氧预处理晶体停搏液对体外循环中肺的保护作用  

Protective effect of oxygen preconditioning crystalloid cardioplegia on lung during cardiopulmonary bypass

作　　者：李美霞[1] 田毅[1] 高韵婷 LI Mei-xia;TIAN Yi;GAO Yun-ting(Department of Anesthesiology,Central South University Xiangya School of Medicine Affiliated Haikou Hospital Haikou 570208,Hainan,CHIN)

机构地区：[1]中南大学湘雅医学院附属海口医院麻醉科,海南海口570208

出　　处：《海南医学》2018年第14期1941-1943,共3页Hainan Medical Journal

基　　金：海南省自然科学基金(编号:813258);海南省卫生厅医学科研项目(编号:琼卫2012PT-56)

摘　　要：目的探讨氧预处理晶体停搏液在体外循环心脏直视手术中对肺的保护作用。方法选择2013年6月至2016年6月在中南大学湘雅医学院附属海口医院择期全麻下行二尖瓣人工机械瓣膜置换术患者40例,采用随机数表法分为观察组和对照组,每组20例。两组患者均采用相同的麻醉、体外循环及手术方式,观察组采用预充氧冷晶体停搏液(St.thomas液+过氧化碳酸酰胺1.0 g/500 m L),灌注心肌停搏,对照组采用冷晶体停搏液(St.thomas液)。检测切皮前(T0)、术毕(T1)、术后6 h(T2)、术后24 h(T3)各时点的白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、丙二醛(MDA)、超氧化物歧化酶(SOD)的含量及呼吸指数(RI);同时记录体外循环时间、主动脉阻断时间、心脏自动复跳及术后多巴胺用量等。结果两组患者的体外循环时间、主动脉阻断时间、自动复跳率、术后多巴胺用量比较差异均无统计学意义(P>0.05);两组患者的IL-6、MDA、RI术后24 h内各时间点较术前有所增加,且观察组术后各时间点各值均明显低于对照组,差异均有统计学意义(P<0.05);术后各组IL-10、SOD均较术前升高,且观察组较对照组升高更明显,差异均有统计学意义(P<0.05)。结论预充氧晶体停搏液比单纯晶体停搏液对肺的保护效果可能更好。Objective To investigate the protective effect of oxygen preconditioning crystalloid cardioplegia on lung under cardiopulmonary bypass（CPB）. Methods A total of 40 patients undergoing mitral valve replacement under general anesthesia in Central South University Xiangya School of Medicine Affiliated Haikou Hospital from June2013 to June 2016 were randomly divided into two groups： experimental group and control group, with 20 cases in each group. Two groups of all received the same anesthesia mode, CPB and surgery. The experimental group received preoxygenated cold crystalloid cardioplegia（St. thomas combined with carbamide peroxide 1.0 g/500 m L） to make cardiac arrest, and the control group was treated with cold crystalloid cardioplegic solution（ST. Thomas）. The levels of interleukin-6（IL-6）, interleukin-10（IL-10）, malondialdehyde（MDA）, superoxide dismutase（SOD） and respiratory index（RI）were respectively detected before resection（T0）, after surgery（T1）, at postoperative 6 h（T2）, at postoperative 24 h（T3）.The CPB time, aortic occlusion time, cardiac resuscitation rate and postoperative dopamine dosage were recorded simultaneously. Results There were no significant differences between the two groups in CPB time, aortic occlusion time,cardiac resuscitation rate and the postoperative dopamine dosage（P〉0.05）. The levels of IL-6, MDA and RI of the two groups increased 24 hours after operation compared with before operation, and the levels at each time point after surgery of the experimental group were significantly lower than those of the control group（P〈0.05）. After operation, the levels of IL-10 and SOD was higher than those before operation, and the levels in the experimental group was significantly higher than those in the control group（P〈0.05）. Conclusion The effect of preoxygenation crystalloid cardioplegia on lung protection is better than that of crystalloid cardioplegia.

关 键 词：体外循环 心脏停搏液 氧预处理 肺 保护 

分 类 号：R654.1[医药卫生—外科学]