肺动脉灌注含腺苷的冷氧合血对体外循环术后肺损伤的临床研究

Lung protection by pulmonary artery perfusion with cold oxygenated blood containing adenosine during cardiopulmonary bypass

目的:探讨体外循环术中肺动脉灌注含腺苷的冷氧合血对肺缺血再灌注损伤的保护效果。方法:选取30例风湿性瓣膜病变合并中重度肺动脉高压患者,随机分为含腺苷的冷氧合血灌注组(腺苷组)和单纯冷氧合血肺动脉灌注组(对照组)各15例。在主动脉阻断后,经肺动脉根部一次性灌注肺保护液,测定两组患者转流前、主动脉阻断后15 min、主动脉开放后15 min、术后122、4 h白细胞(WBC)外周静脉血/动脉血(V/A)比值,并检测血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和丙二醛(MDA)含量水平。结果:术后呼吸机辅助时间腺苷组为(18.6±4.75)h,明显低于对照组(26.4±6.32)h,P<0.05;腺苷组WBC V/A比值、IL-6和TNF-α含量于主动脉阻断后15 min及开放后15 min、术后12 h明显低于对照组,差异有统计学意义(P<0.05)。腺苷组MDA含量在主动脉开放后15 min、术后12、24 h明显低于对照组,差异有统计学意义(P<0.05)。结论:在体外循环中肺动脉灌注含腺苷的冷氧合血对术后肺缺血再灌注损伤有明显的保护作用。

Objective： To evaluate the protective effect of perfusion of the pulmonary artery using cold oxygenated blood containing adenosine on the isebemia-reperfusion injury of the lung during eardiopulmonary bypass. Methods： Thirty patients undergoing heart valve replacement complicated with pulmonary hypotension with eardiopulmonary bypass were randomly divided into the control group （ n = 15, infused with 4 ℃ oxygenated blood） and the adenosine group （ n = 15, infused with 4 ℃oxygenated blood containing adenosine）. The plasma level of TNF-α, IL-6, MDA and the V/A （vein/artery） ratio of WBC were determined before CPB and at 15 minutes after aortic cross-clamp, 15 minutes after aortic cross-clamp release, 12 hours after the operation and 24 hours after the operation. Results： The time of mechanical ventilation was significantly shorter in the adenosine group than that in the control group[ （18.60 ± 4.75）h VS （26.40 ±6.32）h, P 〈 0.05]. Compared with the control group, the WBC V/A,as well as the level of IL-6 and TNF - α of the adenosine group was significantly decreased at 15 minutes after aortic cross-clamp, 15 minutes after aortic cross- clamp release and 12 hours after the operation （ P 〈 0.05）. The level of MDA was also obviously decreased at 15 minutes after aortic cross-clamp release, 12 hours after the operation and 24 hours after the operations（ P 〈0.05）. Conclusion：Perfusion with cold oxygenated blood containing adenosine to the pulmonary artery can more effectively reduce the ischemia-reperfusion injury of the lung than that with only cold oxygenated blood during CPB.