前列地尔对体外循环下心脏瓣膜置换术患者肺损伤的保护作用
发布时间：2018-07-26 09:40
【摘要】：目的：探讨前列地尔对体外循环下心脏瓣膜置换术患者肺损伤的保护作用 方法：选择河北医科大学第二医院心脏外科在体外循环条件下心脏瓣膜置换术的患者30例，随机分为实验组和对照组,每组各15例病人,两组病人的年龄、体重、性别比例、心功能、左室射血分数无显著差异(P＞0.05)。实验组：在麻醉诱导后5min由中心静脉泵入前列地尔2ng/Kg.min,直至手术结束；对照组不予此处理。两组分别在下列时间点采集桡动脉血标本：(1)麻醉诱导后5min（切皮前）(T1)；(2)停体外循环后2小时(T2)；(3)停体外循环后4h(T3)；(4)体外循环后12小时（T4）用ELISA法检测血浆TNF-a，IL-6，IL-8的含量。测动脉血氧分压（PaO2），二氧化碳分压(PaCO2)和吸入氧浓度（FiO2）以计算评估氧合指数（OI）和呼吸指数（RI）。 结果：1两组间患者炎症因子IL-6,IL-8及TNF-a的含量及呼吸功能指标氧合指数OI以和呼吸指数RI在T1时点均无显著差异(P0.05)。2IL-6的变化： 对照组与实验组在T2-T4时点的IL-6浓度与术前T1时点相比明显升高（P0.01），实验组在体外循环后T2-T4时点的IL-6血浆浓度低于对照组（P0.05）3IL-8的变化： 对照组与实验组在T2-T4时点的IL-8浓度与术前T1时点相比明显升高（P0.01），实验组在体外循环后T2-T4时点的IL-8血浆浓度低于对照组（P0.05）4TNF-a的变化： 对照组与实验组在T2-T4时点的TNF-a浓度与术前T1时点的血浆浓度相比明显升高（P0.01），实验组在体外循环后T2-T4时点的TNF-a血浆浓度低于对照组（P0.05）5氧合指数OI的变化比较： 两组患者OI在体外循环前T1时点无差异(P0.05),两组在体外循环后，T2,T3,T4时点与术前相比OI值下降（P0.01），实验组在T2,T3,T4各时点OI值均高于对照组（P0.05）。6患者RI值比较： 两组患者RI在体外循环前T1时点无差异(P0.05)；两组在体外循环后T2-T4各时点与术前T1时点相比明显升高（P0.01），实验组在T2，T3，T4时点RI值低于对照组（P0.05）。 结论：CPB可以导致机体发生炎症反应。在CPB过程中应用前列地尔可抑制炎症因子的产生,降低血浆TNF-a，IL-6，IL-8水平，减轻肺损伤,对体外循环下心脏瓣膜置换术患者具有较好的肺保护作用。
[Abstract]:Objective: to investigate the protective effect of alprostadil on lung injury in patients undergoing cardiopulmonary bypass (CPB). There was no significant difference in age, body weight, sex ratio, cardiac function and left ventricular ejection fraction between the two groups (P > 0.05). Experimental group: after anesthesia induction, 5min was pumped into alprostadil 2 ng / kg 路min by central vein until the end of operation, but not in control group. The blood samples of radial artery were collected at the following time points: (1) after anesthesia induction 5min (before skin incision) (T1); (2) 2 hours after cardiopulmonary bypass (T2); (3), 4 hours after cardiopulmonary bypass (T3); (4) and 12 hours after cardiopulmonary bypass (T4), the level of IL-8 in plasma was detected by ELISA method. Arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and inhaled oxygen concentration (FiO2) were measured to evaluate the oxygenation index (OI) and respiratory index (RI). Results there was no significant difference between the two groups in the content of IL-6, IL-8 and TNF-a and respiratory function index (Oi) and respiratory index (RI) at T1 (P0.05). 2IL-6: control group and experimental group at T2-T4 time. The concentration of IL-6 was significantly higher than that of preoperative T1 (P0.01). The concentration of IL-6 in experimental group at T2-T4 time was lower than that in control group (P0.05) 3IL-8. The IL-8 concentration in control group and experimental group at T2-T4 time was lower than that in control group at T1 time before CPB. Compared with the control group (P0.01), the plasma concentration of IL-8 in the experimental group was lower than that in the control group (P0.05) at the time of T2-T4: the TNF-a concentration of the control group and the experimental group at the time of T2-T4 was significantly higher than that of the control group at T1 time before cardiopulmonary bypass. The plasma concentration of TNF-a in the experimental group was lower than that in the control group (P0.05) at T2-T4 point after CPB (P0.01). There was no difference between the two groups at T1 time before CPB (P0.05), and there was no significant difference between the two groups in T2T3T3 T4 after cardiopulmonary bypass (P05). The OI value of the experimental group was higher than that of the control group (P0.05) at each time point (P0.01). There was no difference between the two groups in RI at T1 time before CPB (P0.05). After cardiopulmonary bypass (CPB), T2-T4 increased significantly at each time point compared with preoperative T1 time point (P0.01), and the RI value of experimental group was lower than that of control group at T2T3T4 time point (P0.05). Conclusion: CPB can induce inflammatory reaction in the body. Alprostadil can inhibit the production of inflammatory factors, decrease the level of IL-6 and IL-8 in plasma TNF-a, alleviate lung injury, and has a better lung protective effect on patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2
本文编号：2145596
[Abstract]:Objective: to investigate the protective effect of alprostadil on lung injury in patients undergoing cardiopulmonary bypass (CPB). There was no significant difference in age, body weight, sex ratio, cardiac function and left ventricular ejection fraction between the two groups (P > 0.05). Experimental group: after anesthesia induction, 5min was pumped into alprostadil 2 ng / kg 路min by central vein until the end of operation, but not in control group. The blood samples of radial artery were collected at the following time points: (1) after anesthesia induction 5min (before skin incision) (T1); (2) 2 hours after cardiopulmonary bypass (T2); (3), 4 hours after cardiopulmonary bypass (T3); (4) and 12 hours after cardiopulmonary bypass (T4), the level of IL-8 in plasma was detected by ELISA method. Arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and inhaled oxygen concentration (FiO2) were measured to evaluate the oxygenation index (OI) and respiratory index (RI). Results there was no significant difference between the two groups in the content of IL-6, IL-8 and TNF-a and respiratory function index (Oi) and respiratory index (RI) at T1 (P0.05). 2IL-6: control group and experimental group at T2-T4 time. The concentration of IL-6 was significantly higher than that of preoperative T1 (P0.01). The concentration of IL-6 in experimental group at T2-T4 time was lower than that in control group (P0.05) 3IL-8. The IL-8 concentration in control group and experimental group at T2-T4 time was lower than that in control group at T1 time before CPB. Compared with the control group (P0.01), the plasma concentration of IL-8 in the experimental group was lower than that in the control group (P0.05) at the time of T2-T4: the TNF-a concentration of the control group and the experimental group at the time of T2-T4 was significantly higher than that of the control group at T1 time before cardiopulmonary bypass. The plasma concentration of TNF-a in the experimental group was lower than that in the control group (P0.05) at T2-T4 point after CPB (P0.01). There was no difference between the two groups at T1 time before CPB (P0.05), and there was no significant difference between the two groups in T2T3T3 T4 after cardiopulmonary bypass (P05). The OI value of the experimental group was higher than that of the control group (P0.05) at each time point (P0.01). There was no difference between the two groups in RI at T1 time before CPB (P0.05). After cardiopulmonary bypass (CPB), T2-T4 increased significantly at each time point compared with preoperative T1 time point (P0.01), and the RI value of experimental group was lower than that of control group at T2T3T4 time point (P0.05). Conclusion: CPB can induce inflammatory reaction in the body. Alprostadil can inhibit the production of inflammatory factors, decrease the level of IL-6 and IL-8 in plasma TNF-a, alleviate lung injury, and has a better lung protective effect on patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2
【引证文献】
相关期刊论文 前1条
1 尹思敏;邹治木;杨磊;赵启邹;聂彩霞;何继竹;;1476份前列地尔注射液超说明书用药医嘱调查[J];中国医院用药评价与分析;2017年02期
，本文编号：2145596
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