不同剂量异丙酚对体外循环患者肺功能的影响

Influence of Different Dosage Propofol on Pulmonary Function in Patients with Cardiopulmonary Bypass

目的:探讨不同剂量异丙酚在体外循环(CPB)心脏瓣膜置换术中对肺功能的影响。方法:选择42例在体外循环下行心脏瓣膜置换术的患者,随机分为对照组(C组)、异丙酚1组(P1组,2μg/mL)及异丙酚2组(P2组,4μg/mL)。P1、P2组气管插管后靶控输注异丙酚,直至手术结束。对照组术中不输注异丙酚。于CPB前(T1)、肺脏再灌注(腔静脉开放)后30 min(T2)、60 min(T3)、120 min(T4)各时间点抽取桡动脉血,检测血气、血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、细胞间黏附分子-1(sICAM-1)、丙二醛(MDA)的浓度及超氧化物歧化酶(SOD)的活性,并根据血气结果计算肺泡-动脉血氧分压差[P(A-a)O2]和呼吸指数(RI)。结果:3组患者T2～T4时P(A-a)O2和RI显著高于T1时(P<0.05),T2～T4时,异丙酚组P(A-a)O2、RI显著低于C组(P<0.05),且P2组明显低于P1组(P<0.05);T2～T4时,异丙酚组TNF-α、IL-6、sICAM-1、MAD浓度显著低于C组(P<0.05),且P2组明显低于P1组(P<0.05);异丙酚组SOD活性显著高于C组,且P2组明显高于P1组(P<0.05)。结论:在CPB期间,靶控输注异丙酚2μg/mL及4μg/mL均能明显抑制炎性因子的释放,减少氧自由基产生,增加机体清除氧自由基的能力,从而减轻CPB所致的肺损伤,有一定的肺功能保护作用,并呈剂量效应关系。

Objective To investigate the effects of different dosage of porpofol on pulmonary function in patients with cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Total 42 patients with cardiac valve replacement under cardiopulmonary bypass(CPB) were randomly divided into group C,group P1 and group P2.In group P1 and P2,propofol were continuously injected with TCI after tracheal intubation till postoperation.No propofol was given in group C.The radial artery blood of all patients were collected at pre-CPB(T1),30 min post-lung reperfusion(T2),60 min(T3),120 min(T4),respectively.The blood gas,the concentrations of TNF-α,IL-6,Sicam-1 and MDA,the activity of SOD were measured.The P(A-a)O2 and RI were calculated based on the blood gas.Results Compared with T1,the P(A-a)O2 and RI in three groups from T2 to T4 were significantly increased(P<0.05).Compared with group C,P(A-a)O2 and RI in propofol group were significantly decreased from T2 to T4(P<0.05).Compared with P1 group,P(A-a)O2 and RI in P2 group were significantly decreased(P<0.05).Compared with group C,the concentrations of TNF-α,IL-6,sICAM-1 and MDA in propofol groups were significantly decreased from T2 to T4(P<0.05),and the concentration in P2 group were significantly less than that of P1 group(P<0.05).Compared with group C,the activity of SOD in propofol groups were significantly increased(P<0.05),and the activity in P2 group were significantly higher than that of P1 group(P<0.05).Conclusion During CPB,propofol administration by TCI with 2 μg/mL and 4 μg/mL could relieve the pulmonary injury through inhibiting the release of inflammatory factors,reducing the production of oxygen free radical,increasing the capability of oxygen free radical clearing.The protective effects on pulmonary function was in a dose dependent manner.