七氟烷预处理在婴幼儿体外循环中对肺功能的保护作用
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摘要
目的:观察七氟烷预处理在婴幼儿体外循环(CPB)心脏直视手术中对肺功能的影响,探讨其肺保护作用及可能机制。方法:选择1岁以内行室间隔缺损修补术的患儿60例,按照随机数字表法分为预处理组和对照组(n=30)。预处理组患儿在全身麻醉诱导完成气管插管后开始持续吸入1.0最小肺内浓度(MAC)七氟烷,直至CPB开始;对照组患儿不吸入七氟烷。记录2组患儿的呼吸机支持时间,比较2组患儿在主动脉阻断前(T0)、主动脉开放30min(T1)、CPB结束后2h(T2)和CPB结束后6h(T3)4个时间点气道平台压(Pplate)、肺顺应性(CL)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)、呼吸指数(RI)及肺隔离白细胞和中性粒细胞计数。结果:与对照组比较,预处理组患儿呼吸机支持时间明显缩短(P<0.05)。与T0时间点比较,2组患儿在T1、T2和T3时间点CL和OI均明显降低(P<0.05或P<0.01),Pplate、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显升高(P<0.05或P<0.01)。与对照组比较,在T1、T2和T3时间点预处理组患儿CL和OI均明显升高(P<0.05或P<0.01),Pplate、A-aDO2、RI、肺隔离白细胞和中性粒细胞计数均明显降低(P<0.05或P<0.01)。结论:在婴幼儿CPB手术中应用七氟烷预处理可以减少白细胞的黏附,保护患儿的肺功能,值得临床推广应用。
Objective:To observe the influence of sevoflurane pretreatment in the lung function of the infants during heart operation by cardiopulmonary bypass(CPB),and to explore its lung protection and possible mechanism.Methods:Sixty infants with ventricular septal defect were enrolled at age less than 1year old and randomly assigned to pretreatment group and control group(n=30).After the induction of general anesthesia and tracheal intubation,the patients in pretreatment group received continuous inhalation of 1.0 MAC sevoflurane until the beginning of CPB.Inhale sevoflurane was absent in control group.The duration of ventilator support of the infants in two groups was recorded.The Pplate,CL,OI,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung of the patients were compared between two groups at the four time points T0(before aorta clamping),T1(30min after aorta declamping),T2,and T3(2hand 6hafter CPB).Results:Compared with control group,the duration of ventilator support of the infants in pretreatment group was obviously shortened(P<0.05).In each group,the CL and OI were significantly decreased(P<0.05 or P<0.01),while the Pplate,A-aDO2,RI,the number of leukocyte and neutrophils segregated in lung were significantly increased(P<0.05 or P<0.01)at T1,T2,T3 time points compared with T0 time point.The CL and OI in pretreatment group were significantly increased(P<0.05 or P<0.01);the Pplate,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung in pretreatment group were significantly decreased at T1,T2,and T3(P<0.05 or P<0.01)compared with control group.Conclusion:Sevoflurane pretreatment might play a role in decreasing the leukocyte adhesion and protecting the lung function in the infants during opening heart operation by CPB.
Objective:To observe the influence of sevoflurane pretreatment in the lung function of the infants during heart operation by cardiopulmonary bypass(CPB),and to explore its lung protection and possible mechanism.Methods:Sixty infants with ventricular septal defect were enrolled at age less than 1year old and randomly assigned to pretreatment group and control group(n=30).After the induction of general anesthesia and tracheal intubation,the patients in pretreatment group received continuous inhalation of 1.0 MAC sevoflurane until the beginning of CPB.Inhale sevoflurane was absent in control group.The duration of ventilator support of the infants in two groups was recorded.The Pplate,CL,OI,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung of the patients were compared between two groups at the four time points T0(before aorta clamping),T1(30min after aorta declamping),T2,and T3(2hand 6hafter CPB).Results:Compared with control group,the duration of ventilator support of the infants in pretreatment group was obviously shortened(P<0.05).In each group,the CL and OI were significantly decreased(P<0.05 or P<0.01),while the Pplate,A-aDO2,RI,the number of leukocyte and neutrophils segregated in lung were significantly increased(P<0.05 or P<0.01)at T1,T2,T3 time points compared with T0 time point.The CL and OI in pretreatment group were significantly increased(P<0.05 or P<0.01);the Pplate,A-aDO2,RI,the number of leukocytes and neutrophils segregated in lung in pretreatment group were significantly decreased at T1,T2,and T3(P<0.05 or P<0.01)compared with control group.Conclusion:Sevoflurane pretreatment might play a role in decreasing the leukocyte adhesion and protecting the lung function in the infants during opening heart operation by CPB.
引文
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[12]Li XH,Liu ZH,Ma HB,et al.Effect of sevoflurane on tissue permeability of lung ischemia-reperfusion injury in rats[J].Asian Pac J Trop Med,2014,7(4):276-279.
[13]Zhao S,Wu J,Guo Q,et al.Effect of different concentrations of sevoflurane pretreatment on acute lung injury induced by endotoxin in rats[J].J Central South Univer Med Sci,2010,35(9):921-927.
[14]Wang C,Xie H,Liu X,et al.Role of nuclear factor-κB in volatile anaesthetic preconditioning with sevoflurane during myocardial ischaemia/reperfusion[J].Eur J Anaesthesiol,2010,27(8):747-756.
[15]Sugasawa Y,Yamaguchi K,Kumakura S,et al.Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection[J].J Anesth,2012,26(1):62-69.
[16]Yang H,Liang G,Hawkins BJ,et al.Inhalational anesthetics induce cell damage by disruption of intracellular calcium homeostasis with different potencies[J].Anesthesiology,2008,109(2):243-250.
[17]Boost KA,Leipold T,Scheiermann P,et al.Sevoflurane and isoflurane decrease TNF-alpha-induced gene expression in human monocytic THP-1cells:potential role of intracellular IκBαregulation[J].Int J Mol Med,2009,23(5):665-671.
[18]王金鑫,史淑珍,李菊红,等.右美托咪定复合七氟烷在小儿烧伤短小手术中的应用效果观察[J].解放军医学杂志,2016,41(3):254-257.
[2]Shi S,Chen C,Zhao D,et al.The role of plasma gelsolin in cardiopulmonary bypass induced acute lung injury in infants and young children:apilot study[J].BMC Anesthesiol,2014,14:67.
[3]Lin EP,Miles L,Hughes EA,et al.A combination of mild hypothermia and sevoflurane affords long-term protection in a modified neonatal mouse model of cerebral hypoxia-ischemia[J].Anesth Analg,2014,119(5):1158-1173.
[4]Voigtsberger S,Lachmann RA,Leutert AC,et al.Sevoflurane ameliorates gas exchange and attenuates lung damage in experimental lipopolysaccharide-induced lung injury[J].Anesthesiology,2009,111(6):1238-1248.
[5]Rodríguez A,TauràP,García Domingo MI,et al.Hepatic cytoprotective effect of ischemic and anesthetic preconditioning before liver resection when using intermittent vascular inflow occlusion:a randomized clinical trial[J].Surgery,2015,157(2):249-259.
[6]Xu Y,Ma LL,Zhou C,et al.Hypercholesterolemic myocardium is vulnerable to ischemia-reperfusion injury and refractory to sevoflurane-induced protection[J].PLoS One,2013,8(10):e76652.
[7]Sun SX,Ge BX,Miao CH.Effects of preconditioning with sevoflurane on TNF-α-induced permeability and activation of p38 MAPK in rat pulmonary microvascular endothelial cells[J].Cell Biochem Biophys,2011,61(1):123-129.
[8]Engels M,Bilgic E,Pinto A,et al.A cardiopulmonary bypass with deep hypothermic circulatory arrest rat model for the investigation of the systemic inflammation response and induced organ damage[J].J Inflamm(Lond),2014,11(1):26-28.
[9]Tsakiridis K,Mpakas A,Kesisis G,et al.Lung inflammatory response syndrome after cardiac-operations and treatment of lornoxicam[J].J Thorac Dis,2014,6(Suppl 1):S78-98.
[10]Du GZ,Gao H,Liu J,et al.Isoflurane pre-treatment before cardiopulmonary bypass alleviates neutrophil accumulation in dog lungs[J].Cardiovasc J Afr,2011,22(3):128-133.
[11]de Amorim CG,Malbouisson LM,da Silva FC Jr,et al.Leukocyte depletion during CPB:effects on inflammation and lung function[J].Inflammation,2014,37(1):196-204.
[12]Li XH,Liu ZH,Ma HB,et al.Effect of sevoflurane on tissue permeability of lung ischemia-reperfusion injury in rats[J].Asian Pac J Trop Med,2014,7(4):276-279.
[13]Zhao S,Wu J,Guo Q,et al.Effect of different concentrations of sevoflurane pretreatment on acute lung injury induced by endotoxin in rats[J].J Central South Univer Med Sci,2010,35(9):921-927.
[14]Wang C,Xie H,Liu X,et al.Role of nuclear factor-κB in volatile anaesthetic preconditioning with sevoflurane during myocardial ischaemia/reperfusion[J].Eur J Anaesthesiol,2010,27(8):747-756.
[15]Sugasawa Y,Yamaguchi K,Kumakura S,et al.Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection[J].J Anesth,2012,26(1):62-69.
[16]Yang H,Liang G,Hawkins BJ,et al.Inhalational anesthetics induce cell damage by disruption of intracellular calcium homeostasis with different potencies[J].Anesthesiology,2008,109(2):243-250.
[17]Boost KA,Leipold T,Scheiermann P,et al.Sevoflurane and isoflurane decrease TNF-alpha-induced gene expression in human monocytic THP-1cells:potential role of intracellular IκBαregulation[J].Int J Mol Med,2009,23(5):665-671.
[18]王金鑫,史淑珍,李菊红,等.右美托咪定复合七氟烷在小儿烧伤短小手术中的应用效果观察[J].解放军医学杂志,2016,41(3):254-257.
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