异丙酚对体外循环患者肺保护作用的临床研究

Protection of Propofol on Pulmonary Function in Patients Undergoing Cardiopulmonary Bypass

目的:通过观察异丙酚对体外循环(CPB)患者中性粒细胞(PMN)核因子κB(NF-κB)活性和肺顺应性的影响,探讨异丙酚肺保护作用机制。方法:将30例行CPB心瓣膜置换术病例随机分成D组(CPB期间异丙酚麻醉维持组)和M组(咪唑安定麻醉维持组),每组15例。分别于麻醉前、CPB开始后30min、CPB停止后30min、4h、24h抽取桡动脉血3ml,运用电泳迁移率实验检测NF-κB活性,使用Datex多功能气体监测仪,观察并记录患者CPB前、停机即刻、术毕气道压力及肺顺应性变化。分别采用配对和非配对t检验进行组内、组间差异的统计学分析,比较两组间PMNNF-κB活性和气道压力、肺顺应性变化。结果:两组患者PMNNF-κB活性在CPB停止后30min达到峰值,观察组在CPB开始后30min、CPB停止后30min、4h、24hPMNNF-κB活性低于对照组。CPB停机即刻,两组患者气道顺应性明显降低,D组患者明显高于M组(P<0.05);术毕P组患者气道顺应性高于M组(P<0.05),且与CPB前相比差异无显著性(P>0.05)。结论:异丙酚可以减低CPB患者PMNNF-κB活性,对CPB期间肺损伤具有一定保护作用。

Objective To study the effects of propofol on the NF-κB activity and pulmonary compliance and explore mechanism of its pulmonary protection. Methods Thirty ASA Ⅱ -Ⅲ patients undergoing cardiac valve replacement surgery with CPB were randomly divided into two groups. Anesthesia was maintained with propfol in group P and with midazolam in group M. 3 milliliter radial artery blood was abstracted before induction of anesthesia, 30 min after CPB, 30 min, 4 hours and 24 hours after CPB finishing. NF-κB activity was tested in electrophoretic mobility shift assay （EMSA）. The variety of pulmonary compliance and peak pressure of airway before CPB, at the end of CPB and surgery was monitored and recorded. The differences between the two groups were analyzed with Student t-test. Results The peak value of NF-κB activity was got 30 min after CPB in both group. The NF-κB activity in group P was lower than that in group D 30 min after CPB, 30 min, 4 hours and 24 hours after CPB finishing. Pulmonary compliance decreased significantly in both groups at the end of CPB, but it was better in group P than that in group M at the end of CPB or at the end of surgery （P 〈 0.05）. Conclusion Propfol can reduce the activity of NK-κB and plays a role on pulmonary protection during CPB.