体外循环下心脏瓣膜置换术中呼出气冷凝液介质浓度变化及其与术后急性呼吸窘迫综合征的关系  

Changes in concentration of exhaled gas condensate medium during extracorporeal circulation in heart valve replacement surgery and its relationship with postoperative acute respiratory distress syndrome

作　　者：潘丽红[1] 孙明飞[1] 饶德新 孟庆江[1] PAN Li-hong;SUN Ming-fei;RAO De-xin;MENG Qing-jiang(Department of Cardiovascular Surgery,the First Affiliated Hospital of Henan University,Kaifeng,Henan 475000,China)

机构地区：[1]河南大学第一附属医院心血管外科,河南开封475000

出　　处：《医药论坛杂志》2024年第24期2605-2609,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200552);二○二二年开封市科技发展计划项目(220319)。

摘　　要：目的 分析体外循环下心脏瓣膜置换术中呼出气冷凝液介质(exhaled breath condensate,EBC)浓度变化及其与术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的关系。方法选取2019年1月—2023年12月期间河南大学第一附属医院78例心脏瓣膜置换术手术患者,根据患者是否合并ARDS分为ARDS组41例和非ARDS组37例,比较两组EBC中8-异前列腺素F2a(8-isoPGF2a)、肿瘤坏死因子-α(TNF-α)、白细胞介素8(IL-8)、白细胞介素6(IL-6)浓度变化,及其与心脏瓣膜置换术手术患者术后ARDS的相关性。结果经重复测量方差分析,EBC中8-isopgF2a、TNF-α、IL-6、IL-8的时点、组间、交互比较,均有统计学意义(P<0.05);经LSD-t检验,与气管插管后立即(T1)时点比较,两组手术结束即刻(T2)、手术后2 h(T3)、手术后6 h(T4)时点EBC中8-isopgF2a、TNF-α、IL-6、IL-8升高(P<0.05),且与非ARDS组比较,ARDS组T2、T3、T4时点EBC中8-isopgF2a、TNF-α、IL-6、IL-8更高(P<0.05)。经Spearman分析,EBC中T2、T3、T4时点的8-isopgF2a、TNF-α、IL-6、IL-8与心脏瓣膜置换术手术术后ARDS呈正相关(P<0.05)。结论心脏瓣膜置换术手术患者EBC中8-isopgF2a、TNF-α、IL-6、IL-8升高,且术后ARDS患者的EBC中8-isopgF2a、TNF-α、IL-6、IL-8水平高于术后非ARDS患者。Objective To analyzed the changes in exhaled breath condensate(EBC)concentration during cardiac valve replacement surgery under extracorporeal circulation and its relationship with postoperative acute respiratory distress syndrome(ARDS).Methods Selected 78 patients undergoing heart valve replacement surgery in the First Affiliated Hospital of Henan University from January 2019 to December 2023.They were divided into an ARDS group of 41 patients and a non ARDS group of 37 patients based on whether they had ARDS.Compared the concentration changes of 8-iso-prostaglandin F2a(8-isoPGF2a),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),and interleukin-6(IL-6)between two groups of EBC,and their correlations with postoperative ARDS in patients undergoing heart valve replacement surgery were analyzed.Results After repeated measures analysis of variance,the time points,between-group,and interaction comparisons of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC were statistically significant(P<0.05);according to the LSD-t test,compared with the immediate time point after tracheal intubation(T1),the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at the immediate time point after surgery(T2),2 hours post-surgery(T3),and 6 hours post-surgery(T4)were elevated in both groups(P<0.05),and compared with the non-ARDS group,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at T2,T3,and T4 time points were higher in the ARDS group(P<0.05).According to Spearman analysis,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at T2,T3,and T4 time points were positively correlated with postoperative ARDS after cardiac valve replacement surgery(P<0.05).Conclusion In patients undergoing heart valve replacement surgery,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC are elevated,and the levels of these markers in EBC are higher in postoperative patients with ARDS compared to those without ARDS.

关 键 词：呼吸窘迫综合征 心脏瓣膜置换术 呼出气冷凝液介质 

分 类 号：R654.2[医药卫生—外科学]