前列腺素E_1在心肺转流中的肺保护作用

Protective effect of PGE_1 on the lungs during cardiopulmonary bypass

目的 研究前列腺素E1（PGE1）对心肺转流（CPB）后肺损伤的保护作用。方法 30例心脏手术病人随机分为对照组和观察组，每组15例。观察组病人于麻醉诱导时从中心静脉持续泵入PGE1（20-30ng·kg^-1·min^-1）至CPB结束。分别于转流前、主动脉开放心脏复跳后15min检测左、右心房血中中性粒细胞（PMN）计数及血浆丙二醛（MDA）浓度，并计算左、右心房差值。记录CPB前、心脏复跳后15min、CPB结束后2h、6h气道峰压及桡动脉血气值，并计算气道阻力（AR）及氧合指数（OI）。结果 （1）CPB后各时点观察组AR、OI显著低于对照组（P〈0．01）。（2）心脏复跳后15min观察组左、右心房血PMN计数差和MDA浓度差明显低于对照组（P〈0．05和P〈0．01）。（3）两组心脏复跳后15min左、右心房血PNM计数差与MDA浓度差之间呈直线相关（r=0．57，P〈0．05）。结论 PGE1可减轻CPB引起的PMN在肺内聚集、降低肺内自由基的产生，并减轻由此引起的肺损伤。

Objective To study the protective effect of prostaglandin E1 （PGE1） on lung injury after cardiopulmonary bypass （CPB）. Methods Thirty patients undergoing open cardiac surgery under CPB were randomly divided into control group and PGE1 group with 15 cases each. The patients in PGElgroup received 20-30 ng· kg^-1 · min^-1 of PGE1 from the induction of anaesthesia to the end of CPB. Blood samples were taken from left and right atrium for the measurements of PMN and MDA before CPB and at 15 min after the heart resuscitation, and their differences between left and right atrium were calculated. Airway resistance（AR） and the oxygenation index （OI） were recorded before CPB,at 15 min after resuscitation,and at 2 and 6h after CPB. Results （1）The AR and OI in PGE1 group were significantly lower than those in control group after CPB（P〈0. 01）. （2）After the heart resuscitation, the difference of PMN count between left and right atrium and MDA content in PGE1 group were significantly lower than those in control group（P〈0. 05,or P〈0. 01）. （3）A linear correlation between PMN and MDA was found both in control and PGE1 groups after the heart resuscitation（r=0. 57, P〈0. 05）. Conclusion PGE1 has a protective effect on the lung injury by effectively reducing the neutrophil sequestration in the lungs and the level of free oxygen radicals produced during CPB.