体外循环对患者肺内致炎与抗炎物质的影响

Effects of lung inflammation media on patients during cardiopulmonary bypass

目的研究心肺转流(CPB)对心脏手术患者肺内致炎与抗炎物质的影响。方法择期心脏瓣膜置换患者20例,在CPB前,主动脉开放心脏复跳1、3、5、10min分别采右心房与肺静脉血检测中性粒细胞(PMN)数量、中性粒细胞黏附分子(CD11b)、丙二醛(MDA)、白细胞介素-10(IL-10)水平及过氧化物歧化酶(SOD)活性水平。结果与CPB前比较,主动脉开放心脏复跳后各时点,患者肺静脉血中PMN的数目,CD11b的表达,MDA的含量,SOD活性和IL-10水平均显著性增加(P<0.05),差异有统计学意义。与右心房比较,心脏复跳后各时点患者肺静脉血中PMN的数目和CD11b的表达明显增加,MDA的含量、SOD活性和IL-10水平在心脏复跳1、3min后显著升高(P<0.05),差异均有统计学意义。结论体外循环过程中肺内致炎性物质增多,引起抗炎性物质的产生亦随之增加,有利于消除炎性反应对肺的伤害。

Objective To study the effects lung inflammation media on patients during cardiopulmo- nary bypass. Methods Twenty patients, scheduled for elective cardiac valvular replacement were under study. Blood samples from pulmonary vein and right atrium were collected simultaneously before CPB, at aortic unclamping 1,3,5 and 10 min to determine the levels of PMN,CDllb,MDA,SOD and IL-10. Results After aortic unelamping,levels of the above substances in pulmonary vein were significantly higher than those of pre- CPB and PMN, CD11 b in pulmonary vein were obviously higher than those in right atrium（ P 〈 0. 05 ）. At aortic unclamping 1,3 min, levels of IL-10, MDA and SOD from pulmonary vein significantly increased by eomparision with substances from right atrium（ P 〈 0.05 ）. Conclusion Lung inflammatory response mediated by CPB occurred, both inflammatory media and anti-inflammatory media were overproduced and set free. Inflammatory media led to lung injury while anti-inflammatory media could protect respiratory function.