前列腺素E1在体外循环中调控炎症反应及肺保护作用的研究

The protective effect of prostaglandin E1 on lungs during cardiopulmonary bypass

目的:研究前列腺素E1(PGE1)调控炎症系统对体外循环(CPB)中肺损伤的保护作用。方法:选取2006年3月至6月24例风湿性心脏瓣膜病手术患者,随机分为对照组和实验组(PGE1治疗组),各12例。实验组于麻醉诱导时从中心静脉泵入PGE1[15ng/(kg·min)]至CPB结束。于转流前5 min、心脏复跳后15 min检测左、右心房血中性粒细胞(PMN)及血小板(Plt)计数。检测转流前5 min(T1)、转流30 min(T2)、心脏复跳后15 min(T3)、CPB结束1h(T4)和6 h(T5)的血清sE-选择素、C反应蛋白(CRP)浓度。记录麻醉诱导后、开胸后、CPB及手术结束时的肺顺应性(CL)及氧合指数(OI)。结果:①两组转流前左、右心房血PMN、Plt无显著差异。心脏复跳后15 min对照组左心房血PMN、Plt明显低于右心房血(P<0.01),实验组左、右心房血PMN、Plt计数无显著差异(P>0.05);②CPB开始后两组sE-选择素的浓度逐渐升高,对照组更为明显(P<0.01);③CPB开始后实验组CRP浓度较对照组明显降低(P<0.01);④CPB结束时,实验组氧合指数(oxygenation index,OI)显著低于对照组(P<0.01),肺顺应性(compliance of lung,CL)显著高于对照组(P<0.01)。结论:PGE1可减轻CPB引起的PNM及Plt在肺内聚集、抑制血管内皮细胞的激活,减轻血管内皮细胞损伤,减少全身炎症反应,并减轻由此引起的肺损伤。

Objective：To investigate the protective effects of prostaglandin E1（PGE1）on lung injury by regulating inflammatory system during cardiopulmonary bypass（CPB）.Methods：From March to June in 2006,a total of 24 patients undergoing cardiac surgeiy were randomly divided into the control group（n=12）and the experimental group（n=12）.Each patient in the experimental group received 15 ng（kg·min）.min^（-1） of PGE1 from the induction of anaesthesia to the end of CPB.Blood PMN and Plt in left and right atrium were measured at 5 min before CPB and 15 min after heart resuscitation.The levels of sE-selectin and CRP in serum were measured at 5 min before CPB,30 min on CPB,15 min after heart resuscitation,1 h and 6 h after CPB.Oxygenation index（OI） and compliance of lung（CL）were also recorded in both groups.Results：①PMN and Plt count in the blood in left atrium were significantly lower than that in right atrium at 15 min after heart resuscitation in the control group（P〈0.01）.②During and after CPB,the level of sE-selectin increased in both groups,but it was significantly higher in the control group than that in the experimental group（P〈0.01）.③During and after CPB,the level of CRP in the experimental group was significantly lower than that in the control group（P〈0.01）.④Compared with the control group,OI was significantly lower（P〈0.01）and CL was significantly higher in the experimental group（P〈0.01）at the end of CPB.Conclusion：PGE1 can effectively reduce the sequestration of neutrophil and platelet in the lungs,inhibit the activation of vascular endothelial cells and protect lungs during CPB.