依达拉奉干预对Stanford A型急性主动脉夹层围术期肺损伤的效果  

Effect of edaravone on the perioperative lung injury following stanford type A aortic dissection

作　　者：袁文[1] 金祺[1] 杨毅[1] 刘楠[1] 侯晓彤[1] 杨波[2] 孙立忠[2] 朱俊明[2] YUAN Wen;JIN Qi;YANG Yi;LIU Nan;HOU Xiao-tong;YANG BO;SUN Li-zhong;ZHU Jun-ming(Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Department of Cardiovascular Surgery,Beijing Aortic Disease Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科危重症中心,北京市100029 [2]首都医科大学附属北京安贞医院心脏外科、北京市大血管疾病诊疗研究中心,北京市100029

出　　处：《中国心血管病研究》2021年第5期392-398,共7页Chinese Journal of Cardiovascular Research

基　　金：国家科技支撑计划项目(2015BAI12B03);国家卫生和计划生育委员会——公益性行业科研专项项目(201402009);北京市科技重大专项课题(Z171100001017083)。

摘　　要：目的探讨应用依达拉奉对Stanford A型主动脉夹层(Stanford type A aortic dissection,AAD)围术期肺损伤患者的疗效。方法选取2016年1月1日至2017年1月1日北京安贞医院心脏外科因Stanford A型主动脉夹层入院手术,围术期符合纳入标准的56例患者,将其随机(简单随机化法,使用RandA1.0软件实现)分为两组,每组28例,实验组应用依达拉奉(30mg溶入0.9%氯化钠溶液中,缓慢静脉滴注,返回ICU后即刻给予,2次/24h,持续至术后72h)加甲泼尼龙琥珀酸钠强化抗炎方案,对照组使用甲泼尼龙琥珀酸钠常规抗炎方案。两组在年龄[(46.7±11.2)岁比(47.3±10.7)岁,P>0.05]、性别(男性71.4%比67.9%,P>0.05)和术后基础急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)[(23.0±4.5)比(24.4±4.7),P>0.05]方面未见统计学差异,具有可比性。同时观察比较两组术后即刻T0、术后6hT6、术后12hT12、术后24hT24、术后48h T48和术后72hT72的氧合指数、乳酸、心率、血压、炎性细胞因子水平、机械通气时间、ICU时间和住院时间等指标的变化。结果相较于对照组,实验组于T6、T12时的氧合指数有明显提高[(174.0±45.2)比(150.0±63.1),P<0.05;(183.2±56.3)比(156.0±47.5),P<0.05)],于T12、T48、T72时的心率明显改善[(96.5±22.3)bpm比(115.9±15.8)bpm,P<0.05;(101.5±19.4)bpm比(120.3±17.9)bpm,P<0.05;(107.0±17.1)bpm比(118.3±18.4)bpm,P<0.05)],炎性细胞因子中丝氨酸蛋白酶抑制剂E1(Human Serpin E1)于T72时有所下降[8.2(4.0,16.7)比18.5(14.4,20.1),P<0.05],人血管生成素-2(Human Angiopoietin-2)于T24、T72时有所下降[2190.3(1940.8,3326.9)比4353.4(3459.0,9395.1),P<0.05;2696.4(2156.7,3784.6)比3929.1(3513.9,4291.4),P<0.05],血管内皮生长因子(VEGF)于T6、T24时有所下降[(264.5±258.0)比(434.4±227.2),P<0.05;(323.2±231.2)比(569.1±406.1),P<0.05],晚期糖基化终末产物受体(receptor for advanced glycation end products,RAGE)于T12、T24、T72时有明显下降[(2016.8±1069.4)比(2919.9±629.0),PObjective To assess the efficacy of Edaravone on perioperative lung injury after surgery for Stanford Type A aortic dissection(AAD).Methods 56 patients recovering from the Stanford type A aortic dissection operation in the Center for Cardiac Intensive Care,Beijing Anzhen Hospital between January 1,2016 and January 1,2017,meeting the inclusion criterion after surgery,were investigated.The patients were random divided into two groups(simple randomization with RandA1.0 software),each group contained 28 patients:the experimental group:Edaravone(30 mg dissolved in 0.9%sodium chloride solution,slowly intravenous drip,immediately after returning to ICU,twice/24 hours,until 72 hours after operation)plus methylprednisolone intensive anti-inflammatory treatment,and the control group:methylprednisolone conventional anti-inflammatory treatment[age(46.7±11.2)years vs.(47.3±10.7)years,P>0.05;male 71.4%vs.67.9%,P>0.05;Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)[(23.0±4.5)vs.(24.4±4.7),P>0.05].The changes of oxygenation index,lactic acid,heart rate,blood pressure,inflammatory cytokine level,mechanical ventilation time,ICU time and hospitalization time were observed and compared between the two groups at T0 immediately after operation,T6 at 6 hours after operation,T12 at 12 hours after operation,T24 at 24 hours after operation,T48 at 48 hours after operation and T72 at 72 hours after operation.Results Compared with the control group,the experimental group had better improved the oxygenation index at T6 and T12[(174.0±45.2)vs.(150.0±63.1),P<0.05;(183.2±56.3)vs.(156.0±47.5),P<0.05]and heart rate at T12,T48 and T72[(96.5±22.3)bpm vs.(115.9±15.8)bpm,P<0.05;(101.5±19.4)bpm vs.(120.3±17.9)bpm,P<0.05;(107.0±17.1)bpm vs.(118.3±18.4)bpm,P<0.05)],reduced Human Serpin E1 of inflammatory cytokines at T72[8.2(4.0,16.7)vs.18.5(14.4,20.1),P<0.05],Human Angiopoietin-2 at T24 and T72[2190.3(1940.8,3326.9)vs.4353.4(3459.0,9395.1),P<0.05;2696.4(2156.7,3784.6)vs.3929.1(3513.9,4291.4),P<0.05],vascular endothelial growth

关 键 词：主动脉夹层 肺损伤 依达拉奉 炎性细胞因子 

分 类 号：R654.2[医药卫生—外科学]