米力农对心肺转流患者肺炎性反应因子的影响

Effects of milrinone on inflammatory responses of the lungs during cardiac surgery under cardiopulmonary bypass

目的探讨米力农对患者肺内血浆中P-选择素、白细胞介素-8(IL-8)和血细胞介素-10(IL-10)水平的影响。方法24例择期行心肺转流(CPB)下心瓣膜置换手术的患者,随机双盲分为米力农组(M组)和对照组(N组),每组12例。分别于CPB转机前、主动脉开放后10min抽取患者肺动脉血(PA)和肺静脉血(PV),测定P-选择素、IL-8和IL-10水平。结果P-选择素、IL-8和IL-10在主动脉开放后10min的PA、PV中血浆浓度均较CPB转机前显著升高(P<0·05)。在主动脉开放后10min时,P-选择素在M组PV中的血浆浓度较PA中血浆浓度显著降低(P<0·05),N组下降不明显,M组PV中与N组比较显著降低(P<0·05);两组中IL-8在PV中的浓度均较PA中显著升高(P<0·05),且N组升高的幅度与M组相比更大(P<0·05);两组IL-10在PV中的浓度均较PA中显著降低(P<0·05),M组在PA及PV中均较同一时点N组值高(P<0·05)。结论米力农可减轻心瓣膜置换术CPB所致急性肺损伤。

Objective To evaluate the effects of milrinone on inflammatory responses of the lungs during cardiac valve replacement under cardiopulmonary bypass （CPB）. Methods Twenty-four ASA HI IV adult patients were randomly assigned to two groups： group M （n= 12） with milrinone infusion, and group N （n= 12） with lactated Ringer＇s solution. Blood was drawn from the pulmonary artery （PA）（T1） and the pulmonary vein （PV） （T2） before CPB, at 10 min of reperfusion after release of the aortic cross-clamp （T3 and T4） respectively. Concentration of P-selectin was measured using a quantitative sandwich enzyme linked-immunosorbent assay （ELISA）. The concentrations of IL-8 and IL-10 serum were measured by radioimmunoassay （RIA）. Results At 10 min of reperfusion, P-selectin, L-8 and IL-10 tended to be higher at T3and T4 than those before CPB （P〈0.05）, P-selectin was lower at T2 than that at T1 in group M, and P-selectin at T4 was lower in group M than that in group N. Concentration of IL-8 at T4 was higher than that at T5 in both groups and increased more significantly in group N than that in group M, and concentration of IL-10 at T4 tended to be low er than that at T3 in both groups, furthermore IL-10 in group A was higher than that in the same blood vessel in group N （P〈0.05）. Conclusion Continuous infusion of milrinone may result in a less inflammatory responses of the lungs during cardiac valve replacement under CPB.