机械通气对体外循环术后炎症反应的影响

The effects of different ventilatory settings on systemic inflammatory responses after cardiopulmonary bypass

目的:探讨体外循环(CPB)术后不同肺通气策略对肌体炎症反应的影响。方法:行室间隔缺损修补术的患者30例,随机分为两组,传统通气组(H组)和保护性肺通气组(L组),于麻醉诱导后、CPB前、CPB结束即刻、CPB结束后6小时取静脉血样测IL-6和IL-8。结果:在体外循环前H组与L组在IL-6与IL-8水平无差异,CPB结束即刻两组的IL-6与IL-8水平均明显升高,而两组间亦无差异性。在CPB结束后6小时两组的IL-6与IL-8水平继续升高,H组升高的更明显,L组仅轻度升高。结论:保护性肺通气策略可以降低体外循环术后的全身炎症反应,有利于患者肺功能的恢复。

Objective：To study whether mechanical ventilation modifies the inflammatory responses in patients undergoing CPB for cardiac surgery. Methods：30 patients with Ventricular Septal Defect（VSD） undergoing CPB for VSD repair were randomized to the group H and group L. Group H received conventional mechanical ventilation with V（T） = 10 to 12 ml/kg ideal body weight and low endexpiratory pressure. Group L received a new protective mechanical ventilation strategy with V（T） = 8 ml/kg ideal body weight with positive end-expiratory pressure of 10 cm H2O. IL-6, IL-8 were determined in plasma before CPB and 0, 6 h after CPB. Results：An plasma mediators increased more in Group H than Group L at the 6h after CPB, while they were same before CPB and 0 h after CPB. Conclusion：According to conventional mechanical ventilation, the protective ventilatory strategy may result in a marked reduction of systemic levels of measured inflammatory markers in patients undergoing CPB for cardiac surgery.