体外循环中山莨菪碱对肺损伤的保护作用
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摘要
目的：体外循环造成的全身性炎症反应及肺的缺血再灌注会造成严重肺的损伤，CPB术后患者的肺功能不同程度下降。因此围术期的肺保护具有重要的意义。山莨菪碱具有抗炎及防护器官缺血再灌注损害的作用，本课题主要研究山莨菪碱对体外循环炎症因子的影响及对肺损伤的保护作用。
方法：24例择期首次行心脏瓣膜置换术患者，ASA分级Ⅱ～Ⅳ级、年龄、体重的差异无显著性。所有患者均无肝肾功能障碍；左室射血分数大于40％；血常规基本正常；无慢性支气管炎、支气管哮喘、青光眼、前列腺肥大；近期无肺部感染及接受类固醇激素治疗等。随机分为山莨菪碱组(A组)和对照组(C组)，每组12例。A组按0.8mg／kg的山莨菪碱于转流开始加入预充液中，经转机进入体内。C组用等量生理盐水代替山莨菪碱，用法同A组，麻醉方案两组相同。分别于诱导切皮前(T_1)、转流30min(T_2)、停CPB1小时(T_3)、4小时(T_4)、24小时(T_5)抽取动脉血，肝素抗凝，测定红细胞压积和动脉血气分析，余血立即以2000r／min高速离心，取上层血浆，置入-20℃冰箱内保存。根据试剂盒说明采用放射免疫法测定血浆TNF-α、IL-6浓度。按公式：RI=[P(A-a)DO_2]/PaO_2=[(Pb-PH_2O)×FiO_2-PaCO_2-PaO_2]/PaO_2计算。Pb为大气压(760mmHg)，PH_2O为室温下饱和水蒸气压(47mmHg)。
结果：两组患者年龄、性别、体重、转流时间、主动脉阻断时间差异无统计学意义(P＞0.05)。两组间血浆IL-6、TNF-α水平和RI值在体外循环前T_1时差异无统计学意义(P＞0.05)。C组T_(2-5)各时点TNF-α、IL-6均高于T_1(P＜0.05)，A组T_(2-5)各时点TNF-α、IL-6浓度明显低于C组同时点值(P＜0.05)，T_3、T_4各时点C组的RI较T_1和A组同时点显著增高(P＜0.05)。RI与IL-6、TNF-α呈正相关，相关系数r分别为0.70和0.67(P＜0.01)。
结论：山莨菪碱能有效地抑制体外循环心脏直视手术围术期促炎细胞因子的释放，因而能减轻体外循环引起的急性炎症反应，从而改善肺功能。
Objective: The purpose of this study was to investigate the effect of anisodamine on lung injury during cardiopulmonary bypass.
Methods: Twenty four patients scheduled for elective valve replacement under cardiopulmonary bypass, which had no significant difference existed between two groups in ASA grade, age and body height,no signs of liver function failure and renal failure; left ventricle ejection fraction exceed 40%; blood routine examination is normal probably; no history of chronic bronchitis, bronchial asthma, glaucoma and prostatauxe; no pulmonary infection or receiving hormone in these days, were randomly divided into two groups of 12 patients each. In the experimental group, the patients received anisodamine 0．8mg/kg by adding into the primary solution at the beginning of by-pass,with control group received normal saline instead of anisodamine. Blood samples were taken from radial artery for determination of IL-6 and TNF-αconcentrations and blood gas analysis before operation(T_1) , 30min after initiation of cpb(T_2) , 1h(T_3) , 4h(T_4) and 24h(T_5) after cpb. Respiratory index was calculated at T_1, T_3, T_4．
Results: The age, sex ratio, body weight, time of cpb and time of blocking aorta had no significant difference in both groups(P>0．05) . The plasma levels of TNF-α,IL-6 and respiratory index had no significant difference in both groups at T_1(P>0．05) . In control group the plasma levels of TNF-α,IL-6 were significantly higher than the baseline values during and after cpb(P<0．05) .TNF-α, IL-6 concentrations and respiratory index were significantly higher in control group than in experimental group after cpb(P<0．05) .Respiratory index was positively correlated with plasma concentration of TNF-αand IL-6．The "r" were 0．70 and 0．67(P<0．01) .
Conclusion: This results show that anisodamine can effectively suppress the production of the cytokine during cpb, so reduce the systemic inflammatory response and protect respiratory function.
方法：24例择期首次行心脏瓣膜置换术患者，ASA分级Ⅱ～Ⅳ级、年龄、体重的差异无显著性。所有患者均无肝肾功能障碍；左室射血分数大于40％；血常规基本正常；无慢性支气管炎、支气管哮喘、青光眼、前列腺肥大；近期无肺部感染及接受类固醇激素治疗等。随机分为山莨菪碱组(A组)和对照组(C组)，每组12例。A组按0.8mg／kg的山莨菪碱于转流开始加入预充液中，经转机进入体内。C组用等量生理盐水代替山莨菪碱，用法同A组，麻醉方案两组相同。分别于诱导切皮前(T_1)、转流30min(T_2)、停CPB1小时(T_3)、4小时(T_4)、24小时(T_5)抽取动脉血，肝素抗凝，测定红细胞压积和动脉血气分析，余血立即以2000r／min高速离心，取上层血浆，置入-20℃冰箱内保存。根据试剂盒说明采用放射免疫法测定血浆TNF-α、IL-6浓度。按公式：RI=[P(A-a)DO_2]/PaO_2=[(Pb-PH_2O)×FiO_2-PaCO_2-PaO_2]/PaO_2计算。Pb为大气压(760mmHg)，PH_2O为室温下饱和水蒸气压(47mmHg)。
结果：两组患者年龄、性别、体重、转流时间、主动脉阻断时间差异无统计学意义(P＞0.05)。两组间血浆IL-6、TNF-α水平和RI值在体外循环前T_1时差异无统计学意义(P＞0.05)。C组T_(2-5)各时点TNF-α、IL-6均高于T_1(P＜0.05)，A组T_(2-5)各时点TNF-α、IL-6浓度明显低于C组同时点值(P＜0.05)，T_3、T_4各时点C组的RI较T_1和A组同时点显著增高(P＜0.05)。RI与IL-6、TNF-α呈正相关，相关系数r分别为0.70和0.67(P＜0.01)。
结论：山莨菪碱能有效地抑制体外循环心脏直视手术围术期促炎细胞因子的释放，因而能减轻体外循环引起的急性炎症反应，从而改善肺功能。
Objective: The purpose of this study was to investigate the effect of anisodamine on lung injury during cardiopulmonary bypass.
Methods: Twenty four patients scheduled for elective valve replacement under cardiopulmonary bypass, which had no significant difference existed between two groups in ASA grade, age and body height,no signs of liver function failure and renal failure; left ventricle ejection fraction exceed 40%; blood routine examination is normal probably; no history of chronic bronchitis, bronchial asthma, glaucoma and prostatauxe; no pulmonary infection or receiving hormone in these days, were randomly divided into two groups of 12 patients each. In the experimental group, the patients received anisodamine 0．8mg/kg by adding into the primary solution at the beginning of by-pass,with control group received normal saline instead of anisodamine. Blood samples were taken from radial artery for determination of IL-6 and TNF-αconcentrations and blood gas analysis before operation(T_1) , 30min after initiation of cpb(T_2) , 1h(T_3) , 4h(T_4) and 24h(T_5) after cpb. Respiratory index was calculated at T_1, T_3, T_4．
Results: The age, sex ratio, body weight, time of cpb and time of blocking aorta had no significant difference in both groups(P>0．05) . The plasma levels of TNF-α,IL-6 and respiratory index had no significant difference in both groups at T_1(P>0．05) . In control group the plasma levels of TNF-α,IL-6 were significantly higher than the baseline values during and after cpb(P<0．05) .TNF-α, IL-6 concentrations and respiratory index were significantly higher in control group than in experimental group after cpb(P<0．05) .Respiratory index was positively correlated with plasma concentration of TNF-αand IL-6．The "r" were 0．70 and 0．67(P<0．01) .
Conclusion: This results show that anisodamine can effectively suppress the production of the cytokine during cpb, so reduce the systemic inflammatory response and protect respiratory function.
引文
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