肺动脉灌注含腺苷的低温氧合血对体外循环术后肺损伤保护作用的临床研究
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摘要
目的：探讨体外循环术中采用含腺苷的低温氧合血实施肺动脉灌注对肺损伤保护作用的效果和机理。
方法：选取30例风湿性瓣膜病变合并中重度肺动脉高压的患者，随机分为含腺苷的低温氧合血肺动脉灌注组(腺苷组)和单纯低温氧合血肺动脉灌注组(对照组)，各15例。在主动脉阻断后，经肺动脉根部一次性灌注肺保护液，腺苷组为含腺苷的低温氧合血，对照组则单纯灌注低温氧合血。测定两组患者转流前、主动脉阻断后15min、主动脉开放后15min、术后12h、24h外周静脉／动脉(V／A)血白细胞(WBC)比值，并检测血清丙二醛(MDA)含量、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平。
结果：1．术后呼吸机辅助时间腺苷组为(18.6±4.75)h，明显低于对照组(26.4±6.32)h(P＜0.05)；
2．两组病例术后外周血WBC V／A比值均于主动脉阻断后15min、主动脉开放后15min和术后12h明显增高，与转流前比较差异有统计学意义(P＜0.05)；血清IL-6和MDA含量于主动脉阻断后15min开始明显增高，主动脉开放后15min时达到峰值，并持续到术后24h，与转流前比较差异有统计学意义(P＜0.01)；TNF-α含量在主动脉阻断后15min、主动脉开放后15min及术后12h均较转流前明显增高，差异有统计学意义(P＜0.05)，并于主动脉开放后15min达到峰值；
3．腺苷组V／A白细胞比值、IL-6和TNF-α含量于主动脉阻断后15min及开放后15min、术后12h明显低于对照组，差异有统计学意义(P＜0.05)。腺苷组MDA含量在主动脉开放后15min、术后12h、24h明显低于对照组，差异有统计学意义(P＜0.05)。
结论：1．腺苷可减轻体外循环术后肺组织损伤；
2．体外循环肺缺血期间采用含腺苷的低温氧合血实施肺动脉灌注，与单纯低温氧合血肺动脉灌注比较，可明显改善缺血期间肺脏的代谢，减轻肺内炎症和再灌注损伤。
意义：本研究从炎症角度出发，探讨了在体外循环肺缺血期间实施含腺苷的低温氧合血肺动脉灌注对肺缺血再灌注损伤的作用效果及机理，为肺保护液在临床的应用提供了新的方向。
Objective:To evaluate the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.
Methods:30 patients undergoing heart valve replacement complicated with pulmonary hypotension with cardiopulmonary bypass were randomly divided into control group (n=15, infused with 4 ℃ oxygenated blood) and adenosine group (n=15, infused with 4 ℃ oxygenated blood containing adenosine) .Plasma level of TNF-α,IL-6,MDA and the V/A (vein/artery) ratio of WBC were measured before CPB and at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations.
Results: 1.The time of mechanical ventilation was significantly shorter in adenosine group than that in control group ((18.60±4.75)h vs(26.40±6.32)h, P<0.05).
2.To both control group and adenosine group, the WBC V/A ratio, the levels of IL-6,TNF-α and MDA all increased significantly after CPB; the increase of WBC V/A ratio lasts to 12 hour after operations, the increase of the levels of IL-6 and MDA lasts to 24 hour after operations, and both peaked at 15 minute after aortic cross-clamp release, the increase of the levels of TNF-αlasts to 12 hour after operations, and also peaked at 15 minute after aortic cross-clamp release.
3.Compared with the control group,the WBC V/A ratio, as well as the levels of IL-6 and TNF-α of adenosine group were significantly lower at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release and 12 hour after operations (P<0.05).And the levels of MDA were obviously lower at 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations
(P<0.05).
Conclusion: 1.Adenosine could reduce the post-CPB lung injury.
2.Perfusion with cold oxygenated blood containing adenosine to pulmonary artery could more effectively reduce the ischemia-reperfusion injury of lung and improve the lung function than that with cold oxygenated blood only during CPB.
Significance:We studied the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.,and the result showed that perfusion of pulmonary artery using cold oxygenated blood containing adenosine could more effectively reduce the ischemia-reperfusion injury of lung than that only with cold oxygenated blood during CPB.The study provides to us a new way to reduce the lung injury caused by CPB.
方法：选取30例风湿性瓣膜病变合并中重度肺动脉高压的患者，随机分为含腺苷的低温氧合血肺动脉灌注组(腺苷组)和单纯低温氧合血肺动脉灌注组(对照组)，各15例。在主动脉阻断后，经肺动脉根部一次性灌注肺保护液，腺苷组为含腺苷的低温氧合血，对照组则单纯灌注低温氧合血。测定两组患者转流前、主动脉阻断后15min、主动脉开放后15min、术后12h、24h外周静脉／动脉(V／A)血白细胞(WBC)比值，并检测血清丙二醛(MDA)含量、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平。
结果：1．术后呼吸机辅助时间腺苷组为(18.6±4.75)h，明显低于对照组(26.4±6.32)h(P＜0.05)；
2．两组病例术后外周血WBC V／A比值均于主动脉阻断后15min、主动脉开放后15min和术后12h明显增高，与转流前比较差异有统计学意义(P＜0.05)；血清IL-6和MDA含量于主动脉阻断后15min开始明显增高，主动脉开放后15min时达到峰值，并持续到术后24h，与转流前比较差异有统计学意义(P＜0.01)；TNF-α含量在主动脉阻断后15min、主动脉开放后15min及术后12h均较转流前明显增高，差异有统计学意义(P＜0.05)，并于主动脉开放后15min达到峰值；
3．腺苷组V／A白细胞比值、IL-6和TNF-α含量于主动脉阻断后15min及开放后15min、术后12h明显低于对照组，差异有统计学意义(P＜0.05)。腺苷组MDA含量在主动脉开放后15min、术后12h、24h明显低于对照组，差异有统计学意义(P＜0.05)。
结论：1．腺苷可减轻体外循环术后肺组织损伤；
2．体外循环肺缺血期间采用含腺苷的低温氧合血实施肺动脉灌注，与单纯低温氧合血肺动脉灌注比较，可明显改善缺血期间肺脏的代谢，减轻肺内炎症和再灌注损伤。
意义：本研究从炎症角度出发，探讨了在体外循环肺缺血期间实施含腺苷的低温氧合血肺动脉灌注对肺缺血再灌注损伤的作用效果及机理，为肺保护液在临床的应用提供了新的方向。
Objective:To evaluate the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.
Methods:30 patients undergoing heart valve replacement complicated with pulmonary hypotension with cardiopulmonary bypass were randomly divided into control group (n=15, infused with 4 ℃ oxygenated blood) and adenosine group (n=15, infused with 4 ℃ oxygenated blood containing adenosine) .Plasma level of TNF-α,IL-6,MDA and the V/A (vein/artery) ratio of WBC were measured before CPB and at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations.
Results: 1.The time of mechanical ventilation was significantly shorter in adenosine group than that in control group ((18.60±4.75)h vs(26.40±6.32)h, P<0.05).
2.To both control group and adenosine group, the WBC V/A ratio, the levels of IL-6,TNF-α and MDA all increased significantly after CPB; the increase of WBC V/A ratio lasts to 12 hour after operations, the increase of the levels of IL-6 and MDA lasts to 24 hour after operations, and both peaked at 15 minute after aortic cross-clamp release, the increase of the levels of TNF-αlasts to 12 hour after operations, and also peaked at 15 minute after aortic cross-clamp release.
3.Compared with the control group,the WBC V/A ratio, as well as the levels of IL-6 and TNF-α of adenosine group were significantly lower at 15 minute after aortic cross-clamp, 15 minute after aortic cross-clamp release and 12 hour after operations (P<0.05).And the levels of MDA were obviously lower at 15 minute after aortic cross-clamp release ,12 hour after operations and 24 hour after operations
(P<0.05).
Conclusion: 1.Adenosine could reduce the post-CPB lung injury.
2.Perfusion with cold oxygenated blood containing adenosine to pulmonary artery could more effectively reduce the ischemia-reperfusion injury of lung and improve the lung function than that with cold oxygenated blood only during CPB.
Significance:We studied the protective effect of perfusion of pulmonary artery using cold oxygenated blood containing adenosine on the ischemia-reperfusion injury of lung during cardiopulmonary bypass.,and the result showed that perfusion of pulmonary artery using cold oxygenated blood containing adenosine could more effectively reduce the ischemia-reperfusion injury of lung than that only with cold oxygenated blood during CPB.The study provides to us a new way to reduce the lung injury caused by CPB.
引文
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