七氟醚对体外循环心脏换瓣手术患者血清内皮素-1、一氧化氮水平和肺功能的影响  

Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：吕洁萍[1] 田首元[1] 聂丽霞[1] 郝倩 周莉 Lyu Jieping;Tian Shouyuan;Nie Lixia;Hao Qian;Zhou Li(Department of Anesthesiology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Jiaxing,Jiaxing 314000,China;Department of Anesthesiology,the Third Hospital of Datong,Datong 037008,China)

机构地区：[1]山西医科大学第一医院麻醉科,太原030001 [2]浙江省嘉兴市第二医院麻醉科,314000 [3]山西省大同市第三人民医院麻醉科,037008

出　　处：《中华临床医师杂志（电子版）》2017年第18期2211-2216,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山西省应用基础研究自然科学基金项目(201601D102068)

摘　　要：目的探讨在缺血再灌注早期应用七氟醚对体外循环心脏换瓣手术患者肺功能和血清内皮素-1(ET-1)、一氧化氮(NO)水平的影响。方法择期行瓣膜置换术的风湿性心脏病患者40例随机分为对照组(C组)和七氟醚组(S组),每组20例。两组均采用全静脉麻醉维持,S组在阻断升主动脉前吸入2%七氟醚15 min,阻断升主动脉后继续经膜式氧合器吸入2%七氟醚15 min;开放升主动脉前15 min经膜肺吸入2%七氟醚预充,开放升主动脉后持续吸入2%七氟醚15 min。C组不吸入七氟醚,其他处理同S组。时点界定为:T_0(麻醉后切皮前)、T_1(转机开始前即刻)、T_2(停机即刻)、T_3(停机后2 h)、T_4(停机后6 h)、T_5(停机后24 h)。分别在T_0、T_2、T_3、T_5抽取桡动脉血测定血清ET-1、NO水平。在T_1、T_2时点分别抽取肺动脉、肺静脉血测定其中性粒细胞计数、肺泡表面活性物质A(SP-A)浓度并计算二者差值。分别在T_0、T_2、T_3、T_4、T_5时间点进行动脉血气分析,并计算氧合指数(OI)、肺泡-动脉氧分压差[P_(A-a)O_2]、肺静态顺应性(Cst)。结果 (1)S组ET-1水平(pg/ml)在T_2(6.6±1.8)、T_3(5.9±1.4)、T_5(4.3±1.2)时点较T_0(2.2±1.5)明显升高(P<0.05);C组ET-1水平(pg/ml)在T_2(7.9±0.7)、T_3(7.1±1.3)、T_5(5.8±0.9)时点较T_0(2.3±1.1)明显升高(P<0.05);S组ET-1水平在T_2、T_3、T_5时点较C组明显降低(P<0.05)。S组NO水平(nmol/ml)在T_2(8.6±1.8)、T_3(8.2±1.4)、T_5(6.9±1.7)时点较T_0(5.9±1.2)明显升高(P<0.05);C组NO水平(nmol/ml)在T_2(7.3±1.1)、T_3(7.0±1.1)、T_5(6.1±1.4)时点较T_0(5.1±0.8)明显升高(P<0.05);S组NO水平在T_2、T_3、T_5时点较C组明显升高(P<0.05)。(2)两组T_2时点肺动脉、肺静脉血中性粒细胞计数及其差值均较T_1时明显增加(P<0.05);T_2时点肺动脉、肺静脉血中性粒细胞计数及其差值S组明显少于C组(P<0.05)。两组T_2时点肺动脉、肺静脉血SP-A浓度及其差值均较T_1时明显增加(P<0.05);T_2时点肺Objective To evaluate the effect of sevoflurane inhalation in the early stage of ischemia and reperfusion on pulmonary function and plasma levels of endothelin-1(ET-1)and nitric oxide(NO)in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into two groups(n=20 each):control group(group C)and sevoflurane group(group S).All patients were treated with total intravenous anesthesia.In group S,2%sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked,and before and after the ascending aorta was opened.Sevoflurane inhalation was not given in group C.The time points used were after anesthesia and before skin incision(T0),immediately before CPB(T1),immediately after CPB(T2),2 h after CPB(T3),6 h after CPB(T4),and 24 h after CPB(T5).At T0,T2,T3,and T5,radial artery blood was obtained to detect plasma levels of ET-1 and NO.At T1 and T2,pulmonary artery and pulmonary vein blood was obtained to detect neutrophil count and SP-A to calculate the difference between the vein and artery.At T0,T2,T3,T4,and T5,arterial blood gas was measured to calculate P(A-a)O2,OI,and Cst.Results Plasma levels of ET-1(pg/mL)were significantly higher at T2(6.6±1.8),T3(5.9±1.4),and T5(4.3±1.2)than at T0(2.2±1.5)in group S(P<0.05),and at T2(7.9±0.7),T3(7.1±1.3),and T5(5.8±0.9)than at T0(2.3±1.1)in group C(P<0.05);compared with group C,e plasma ET-1 levels were significantly decreased in group S at T2,T3,and T5(P<0.05).Plasma levels of NO(nmol/mL)were significantly higher at T2(8.6±1.8),T3(8.2±1.4),and T5(6.9±1.7)than at T0(5.9±1.2)in group S(P<0.05),and at T2(7.3±1.1),T3(7.0±1.1),and T5(6.1±1.4)than at T0(5.1±0.8)in group C(P<0.05);compared with group C,plasma NO levels were significantly higher in group S at T2,T3,and T5(P<0.05).The neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were si

关 键 词：七氟醚 内皮素-1 一氧化氮 体外循环 

分 类 号：R614[医药卫生—麻醉学]