CPB期间血氧分压在60和170mmHg的心内直视手术患者心肝肾损伤、炎症、氧化应激指标观察

发布时间：2019-05-25 01:36

【摘要】：目的比较体外循环(CPB)期间血氧分压控制在60、170 mmHg的心内直视手术患者心肝肾损伤指标、炎症因子、氧化应激指标变化。方法 80例择期行心内直视手术患者随机分为低氧组和高氧组各40例,低氧组、高氧组在CPB期间血氧分压分别控制在60、170 mmHg。分别于术前及开主动脉后30 min、2 h、6 h、24 h(T0~T4)抽取患者静脉血,采用全自动生化分析仪检测血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、肌酐(Cr)、尿素氮(UN)、尿酸(UA),ELISA法检测血清心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α),采用试剂盒检测血清活性氧(ROS)、丙二醛(MDA)。结果与同组T0时点比较,两组T_1~T_4时点cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平升高(P均0.05);与高氧组比较,低氧组T2~T4时点cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平降低(P均0.05)。与同组T0时点比较,两组T_1~T_4时点CRP、TNF-α、IL-6水平升高(P均0.05);与高氧组比较,低氧组T_1~T_4时点CRP、TNF-α、IL-6水平降低(P均0.05)。与同组T0时点比较,两组T_1~T_4时点ROS、MDA水平升高(P均0.05);与高氧组比较,低氧组T_1~T_4时点ROS、MDA水平降低(P均0.05)。结论相对于高血氧分压,心内直视手术患者CPB期间采用低血氧分压能够显著降低由CPB引发的心肝肾损伤、炎症反应及氧化应激。
[Abstract]:Objective to compare the changes of heart, liver and kidney injury, inflammatory factors and oxidative stress in patients undergoing open heart surgery with 60170 mmHg partial pressure of blood oxygen during cardiopulmonary bypass (CPB). Methods 80 patients undergoing elective open heart surgery were randomly divided into hypoxia group (n = 40) and hyperoxia group (n = 40). The partial pressure of blood oxygen in hyperoxia group was controlled at 60170 mmHg. during CPB. Venous blood samples were taken before operation and 30 min,2 h, 6 h, 24 h (T0~T4), respectively. Serum glutamic oxaloacetic transaminase (AST), glutamic pyruvic transaminase (ALT), alkaline phosphatase (ALP), was detected by automatic biochemical analyzer. Serum cardiac troponin (cTnI), creatine kinase isoenzyme (CK-MB), C reactive protein (CRP), IL 6 (IL-6) was detected by creatine (Cr), urea nitrogen (UN), uric acid (UA), ELISA method. Tumor Necrosis Factor 伪 (TNF- 伪) was used to detect malondialdehyde (MDA) (MDA). In serum reactive oxygen species (ROS),) by kit. Results compared with the T0 time point of the same group, the cTnI,CK-MB,AST,ALT,ALP,Cr,UN,UA level of T_1~T_4 in the two groups was higher than that in the same group (P 0.05). Compared with hyperoxia group, the level of cTnI,CK-MB,AST,ALT,ALP,Cr,UN,UA at T2~T4 time point in hypoxia group was lower than that in hyperoxia group. Compared with T0 time point in the same group, the levels of CRP,TNF- 伪 and IL-6 at T_1~T_4 time point in both groups were higher than those in hyperoxia group, and the levels of CRP,TNF- 伪 and IL-6 at T_1~T_4 time point in hypoxia group were lower than those in hyperoxia group. Compared with the T0 time point of the same group, the ROS,MDA level of T_1~T_4 in the two groups was higher than that in the hyperoxia group, and the ROS,MDA level at the T_1~T_4 time point in the hypoxia group was lower than that in the hyperoxia group. Conclusion compared with hyperoxia, hypooxia during CPB can significantly reduce the heart, liver and kidney injury, inflammatory reaction and oxidative stress induced by CPB.
【作者单位】： 河北医科大学第三医院;
【基金】：河北省医学科学研究重点课题(20150731)
【分类号】：R654.2

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