体外循环后炎性因子变化及对肺功能的影响

目的探讨体外循环（CPB）后血浆内皮素（ETI）、一氧化氮（NO）、细胞黏附因子（CD11b）、白介素-6（IL-6）、白介素-8（IL-8）的变化及对肺功能的影响。方法32例心血管择期手术病人，在全麻中低温CPB下手术。于术前至术后8h共5个点采血，测定血浆ET1、NO、CD11b、IL-6、IL-8的变化，同时测定肺功能并观察CPB前、后肺组织电镜下的变化。结果体外循环后肺顺应性显著下降、吸气阻力和呼气阻力、峰值压力和平台压力显著升高。CPB后ET1、NO、CD11b、IL-6、IL-8均有不同程度的改变，肺组织病理检查见肺内大量中性粒细胞聚集，有的小血管内可见粒细胞微栓形成，术后肺组织损伤明显。结论在心血管CPB手术中，CPB可导致机体急性全身性炎性改变，ET1、NO、CD11b、IL-6、IL-8变化明显；同时，肺功能降低，肺组织损伤，其改变有相关性。

Objective To study cardiopulmonary bypass （CPB） induced systemic inflammatory responseand lung injury, and to evaluate their relationship. Method 32 cases of heart disease weres tudied. Lung compliance, inspiratory and expiratory resistance, airway peak pressure and plateau pressure, endothelin（ET） ,natric oxide（NO） ,adhesion molecule of the surface msrkers of leukocyte（CDllb） , interleukin -6（IL-6） , interleukin -8（IL-8） , were assessed before and after CPB. Result After CPB, lungeompliance decreased significantly. Inspiratory and expiratory resistance, peakp ressure and plateaup ressure, ET1, NO, CD11 b,IL- 6, IL- 8 increased significantly. Conclusion CPB can induce systemic inflammatory responsein which ET1, NO, CDllb,IL -6 and IL- 8 change significantly; also it is related to lung injury and decrease of pulmonary function too.