急性主动脉夹层围术期急性肺损伤与血管紧张素Ⅱ的相关性  

The correlation between the acute lung injury and AngⅡin perioperative period of acute aortic dissection

作　　者：许志锋[1] 韩振[1] 吴永前[1] 冯钢[1] 任明明[1] 温远祥 郭荣龙 XU Zhi-feng;HAN Zhen;WU Yong-qian;FENG Gang;REN Ming-ming;WEN Yuan-xiang;GUO Rong-long(Department of Cardiovascular Surgery,Peking University Shenzhen Hospital,Shenzhen 518036,Guangdong,China)

机构地区：[1]北京大学深圳医院心血管外科,广东深圳518036

出　　处：《广东医学》2020年第6期585-588,共4页Guangdong Medical Journal

基　　金：深圳市卫生计生系统科研项目(SZFZ2017074)。

摘　　要：目的探讨急性主动脉夹层围术期急性肺损伤(ALI)的发生与循环血中血管紧张素Ⅱ(AngⅡ)的相关性。方法纳入急性主动脉夹层并行急诊手术治疗患者109例(其中Standford A型23例,Standford B型86例)。根据围术期发生ALI的情况分组:a组(13例)术前、术后均发生ALI;b组(25例)术前未发生ALI,但术后发生ALI;c组(71例)术前术后均未发生ALI。各组结果组比较采用方差分析方法,AngⅡ与氧合指数(PaO2/FiO2)相关性采用Pearson相关分析。结果术前三组AngⅡ水平比较差异有统计学意义(F=29.03,P<0.01),a组与b组和c组比较差异有统计学意义(均P<0.05);b组与c组比较差异无统计学意义(P>0.05)。三组术后24、48 h AngⅡ浓度比较,差异均有统计学意义(P<0.05);组间两两比较:a组与c组、b组与c组差异有统计学意义(P<0.05),a组与b组差异无统计学意义(P>0.05)。三组患者术后呼吸机使用时间和ICU停留时间比较:a组与c组、b组与c组均差异有统计学意义(P<0.05);a组与b组差异无统计学意义(P>0.05)。AngⅡ与氧合指数(PaO2/FiO2)呈负相关(r=-0.602,P<0.05)。术后有3例患者死亡,2例二次开胸探查,6例存在其他系统严重并发症。此11例患者术后均合并ALI。结论急性夹层围术期合并ALI的患者,循环血中均有一个较高的AngⅡ水平,而且AngⅡ与PaO2/FiO2呈负相关性;术后发生ALI的患者,呼吸机使用时间与ICU停留时间显著延长。Objective To analyze the correlation between the acute lung injury(ALI)and Ang Ⅱ in perioperative period of acute aortic dissection.Methods A total of 109 cases of acute aortic dissection were included.The cases were grouped according to perioperative ALI situation,Group A(n=13,perioperative ALI),Group B(n=25,only preoperative ALI),Group C(n=71,no perioperative ALI).Analysis of variance was applied for analysis.The correlation between Ang Ⅱ and oxygenation index(PaO2/FiO2)was conducted using Pearson correlation analysis.Results There was significant difference in Ang Ⅱ among the 3 groups before operation(F=29.03,P<0.01).There was significant differences in Ang Ⅱ between Group A and Group B,and between Group A and Group C(P<0.05).Results of 24 h and 48 h after surgery showed there were significant differences in Ang Ⅱ between Group A and C,and between Group B and C(P<0.05).There was significantly negative correlation between Ang Ⅱ and PaO2/FiO2(r=-0.576,P<0.05).There were significant differences in ventilation time and ICU residence time among the 3 groups after surgery(P<0.05).There were 3 deaths,2 cases required secondary exploratory thoracotomy and 6 cases with serious postoperative complications;and all the 11 patients were with postoperative ALI.Conclusion The acute dissection patients with perioperative ALI have high Ang Ⅱ level.Ang Ⅱ and PaO2/FiO2 present a negative correlation.Ventilation time and ICU residence time of the patient with postoperative ALI are significantly prolonged.

关 键 词：急性主动脉夹层 急性肺损伤 血管紧张素Ⅱ 

分 类 号：RR543.16[医药卫生—呼吸系统] R563.8[医药卫生—内科学]