缺血及再灌注早期应用七氟醚对心脏瓣膜置换术患者血清IL-8、NO及ET-1的影响

发布时间：2018-08-31 14:10

【摘要】：目的:在缺血早期和再灌注早期对体外循环下行心脏瓣膜置换术的患者应用2%七氟醚,观察七氟醚处理对中性粒细胞、IL-8、NO、ET-1及跨肺单核细胞的影响。方法:采取随机对照的方法将40例择期行体外循环下心脏瓣膜置换术的患者分为七氟醚组(S组)和对照组(C组),每组各20例。S组在阻断升主动脉前15min吸入2%七氟醚持续到阻断升主动脉后15min,开放升主动脉前吸入2%七氟醚15min持续到开放升主动脉后15min。C组不吸入七氟醚,其余处理同S组。检测麻醉后开胸前(T1)、CPB开始时(T2)、CPB停机时(T3)、停机后2 h(T4)、停机后6h(T5)、停机后24h(T6)桡动脉血中NO、ET-1、IL-8的浓度及中性粒细胞百分比。并在T2、T3时收集肺动脉血和肺静脉血进行单核细胞计数,计算其跨肺差值。将所收集的数据进行统计学处理。结果:组内比较:与T1时相比,两组IL-8、ET-1、NO水平及中性粒细胞百分比在T2到T6时均升高(P0.05);两组单核细胞跨肺差值在体外循环结束时均明显升高(P0.05)。组间比较:两组各指标在体外循环开始前(基础值)无统计学差异(P0.05);T2到T6时S组IL-8、ET-1血清浓度及中性粒细胞百分比均低于C组(P0.05),T2到T6时S组NO血清浓度均高于C组(P0.05),体外循环结束时(T3)S组单核细胞跨肺差值明显低于C组(P0.05)。结论:在肺缺血早期和再灌注早期给予CPB患者2%七氟醚处理,可以提高NO、降低ET-1水平,减少IL-8、中性粒细胞的产生,减轻单核细胞在肺内的聚集,减轻体外循环所致的炎性损伤。
[Abstract]:Aim: to observe the effects of sevoflurane on neutrophil IL-8 and transpulmonary monocytes in patients undergoing cardiac valve replacement under cardiopulmonary bypass at the early stage of ischemia and reperfusion. Methods: 40 patients undergoing elective cardiac valve replacement under cardiopulmonary bypass were randomly divided into sevoflurane group (group S) and control group (group C). 20 patients in group S inhaled 2% sevoflurane (15min) before blocking ascending aorta. The ethers lasted until 15 min after the aortic occlusion, 2% sevoflurane 15min was inhaled before opening the ascending aorta, and no sevoflurane was inhaled in the 15min.C group after opening the ascending aorta. The other treatments were the same as group S. The concentration of NO,ET-1,IL-8 and the percentage of neutrophils in radial artery (T6) 24 hours after anesthesia were measured at the beginning (T _ 2), 2 h (T _ 4), 6 h (T _ 5) and 24 h (T _ 6) after anesthesia. Pulmonary artery blood and pulmonary vein blood were collected at T _ 2 T _ 3 for monocyte count and transpulmonary difference was calculated. The collected data are statistically processed. Results: compared with T1, the level of IL-8,ET-1,NO and the percentage of neutrophils in both groups increased from T2 to T6 (P0.05), and the transpulmonary difference of monocytes increased significantly at the end of cardiopulmonary bypass (P0.05). Comparison between the two groups: there was no significant difference between the two groups before the beginning of cardiopulmonary bypass (P05). The serum concentration of IL-8,ET-1 and the percentage of neutrophils in group S were lower than those in group C (P0.05). The serum concentration of NO in group S was higher than that in group C (P0.05). At the end of cardiopulmonary bypass (T3), the transpulmonary difference of monocytes in group S was significantly lower than that in group C (P0.05). Conclusion: 2% sevoflurane treatment in patients with CPB at the early stage of pulmonary ischemia and reperfusion can increase the level of ET-1, decrease the production of IL-8, neutrophils, reduce the accumulation of monocytes in the lung and alleviate the inflammatory injury induced by cardiopulmonary bypass.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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