吸入左旋精氨酸对心内直视术后肺缺血再灌注损伤的保护作用

Protection of Lung Ischemia Reperfusion Injury of Patients by Atomized Inhalation of NO Precursor after Cardiopulmonary Bypass Surgery

【目的】本实验旨在评估风湿性心脏病术后雾化吸入左旋精氨酸对肺缺血再灌注的保护作用。【方法】将32例风湿性心脏病行瓣膜置换术的患者随机分成两组,精氨酸组(A组)于术后雾化吸入左旋精氨酸,对照组(B组)雾化吸入同等剂量的生理盐水。观察患者治疗前后氧合指数(OI),肺泡-动脉氧分压差(PA-aO2),肺内分流差(QS/Qt)以及血浆一氧化氮(NO)及丙二醛(MDA)浓度的变化。【结果】处理组与对照组比较,能增加血浆NO含量(P<0.01)并能减少血浆MDA水平(P<0.05)且PA-aO2及QS/Qt低于对照组(P<0.05),OI高于对照组(P<0.01)。【结论】术后雾化吸入左旋精氨酸能有效缓解肺缺血再灌注损伤,改善肺功能。

To observe the protective effect of atomized inhalation of L-arginine after cardiopulmonary bypass surgery （CPB） on lung ischemia reperfusion injury of patients with rheumatic heart disease（RHD）. [Methods] Thirty two patients with RHD were divided into two groups randomly. Group A inhaled L-arginine after CPB surgery. Group B inhaled equal dose of sodium chloride as the contrast. Oxygen index （OI）, alveolar-arterial PO2 difference （PA-aO2）, intrapulmonary shunt fraction （QS/Qt） were figured out according blood gas analysis. Nitrogen monoxidum （NO）, malondialdehyde （MDA） in plasma were detected respectively. [Results] NO level in plasma increased in Group A. The parameters of pulmonary function such as PA-aO2, QS/Qt and OI also showed better results in group A. [Conclusion] Atomized inhalation of L-arginine has positive effects for lung ischemia reperfusion injury, and has beneficial aspects for improving lung function.