肺动脉灌注去白细胞肺保护液对体外循环肺的保护作用

Lung Protection by Perfusing the Leukocyte-depleted Protective Solution to Pulmonary Artery During Cardiopulmonary Bypass

目的探讨肺动脉灌注去白细胞肺保护液对体外循环(CPB)肺的保护作用及其机制。方法将30例CPB下行二尖瓣置换术患者随机分为3组:去白细胞肺保护组(A组)、普通肺保护组(B组)及对照组(C组),每组10例。A组CPB期间经肺动脉灌注低温去白细胞肺保护液;B组CPB期间经肺动脉灌注低温肺保护液,C组患者常规行瓣膜置换术。监测3组患者术中主动脉阻断时间、CPB时间、术前术后平均肺动脉压力(PAPm)、气道阻力(AR)及静态肺顺应性(CLS)的变化、术后呼吸机辅助时间、ICU监护时间和住院时间以及术后并发症发生情况等;测定3组患者CPB前和CPB后0、6、12、24h血清丙二醛(MDA)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)的变化。结果3组患者手术顺利,均痊愈出院,无术后并发症。3组术中主动脉阻断时间、CPB时间、术后ICU监护时间、住院时间及CPB前血清MDA、IL-6、TNF-α含量比较,差异均无统计学意义(均P>0.05);A、B组的术后呼吸机辅助时间、CPB后0、6、12、24h呼吸指数(RI)、氧合指数(OI)、血清MDA、IL-6、TNF-α及术前、术后PAPm、CLS、AR变化与C组比较差异均有统计学意义(均P<0.05);临床及生化指标在A、B组比较差异均无统计学意义(均P>0.05)。结论CPB期间肺动脉灌注去白细胞肺保护液可明显减轻CPB肺损伤,与单纯CPB期间经肺动脉灌注低温肺保护液比较,两者肺保护效果无明显差别。

Objective To discuss the lung protection and the mechanism by perfusing the leukocyte-depleted hypothermic protective solution to the pulmonary artery during cardiopulmonary bypass. Methods Thirty cases undergoing mitral valve replacement （MVR） under cardiopulmonary bypass were randomly divided into three groups：leukocyte depleted lung protective group （A,n=10）, common lung protective group （B,n= 10） and control group（C,n= 10）. Leukocyte depleted hypothermic protective solution was infused into the main pulmonary artery in group A; hypothermic protective solution was infused into the main pulmonary artery in group B, and nothing was infused into the main pulmonary artery in group C（common MVR）. Some clinical indexes were monitored （including the time of aortic artery interdietion（Al）and CPB during operation,the variations of mean pulmonary arterial pressure, airway resistance and static compliance of lung before and after operationt, the time of using respirator to assisted respiration,-ICU-staying and days of hospitalization, and having postoperative complications or not）. Concentrations of plasma malondialdehyde （MDA）, tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6） were measured at different time point around the eardiopulmonary bypass. Results The variations of time for aortery clamp, CPB, ICU-staying and hospitalization, concentrations of plasma MDA, TNF-α,IL-6 before CPB were no signifieiant differences in 3 groups（P〉0. 05）. The variation of time for intubation was statistical different between group A and C（P〈0.05）, which was also showed between group B and C. The variations of OI,RI,concentrations of plasma MDA, TNF-α, IL-6 at 0 h,6 h,12 h,24 h after CPB were statistical different between group A and C（P〈0.05）, which were also showed between group B and C. The variations of PAPm,AR and CLS between pre-and-postoperation were statistical different between group A and C（P〈0. 05） ,which were also showed between group B and C. However, the clinical and biochemical indicator monitored above were no significant differences between group A and B（P〉0. 05）. Conclusion Leukocytedepleted hypothermic protective solution perfused through pulmonary artery could significantly reduce the lung injury after CPB. However,compared with the group whieh perfused hypothermic protective solution to pulmonary artery during CPB, the effects of lung protection could not be better.