低温肺保护液肺动脉灌注在体外循环中的肺保护作用

Lung protection of pulmonary artery perfusion with hypothermic protective solution during cardiopulmonary bypass

目的研究低温肺保护液在体外循环（CPB）心脏直视手术中对肺损伤的保护作用。方法选择30例重度肺动脉高压先心病患者，随机分为对照组和肺保护组，每组15例。肺保护组CPB术中一次性从肺动脉灌注低温肺保护液，对照组未行肺动脉灌注。分别于麻醉诱导前（T1），阻断升主动脉30min（T2），CPB结束后1h（T3）、24h（T4）、36h（T5）取桡动脉血标本动态检测两组患者各时间点的肿瘤坏死因子-α（TNF-α）、白细胞介素-10（IL-10）；在T1、T3、T4、T5各时间点对比观察两组术后肺泡一动脉血氧分压差（A—aDO2）和呼吸指数（RI）。结果两组一般资料差异无统计学意义（P〉0．05）；CPB开始后，两组桡动脉血TNF-α、IL-10进行性增高。TNF-α于CPB结束后1h达到最高[对照组（148．42±23．10）ng／L，保护组（103．29±32．15）ng／L]，后逐渐下降，但仍高于CPB前，对照组增高更显著（P〈0．01）。IL-10于CPB结束后24h达到最高[对照组（66．75±25．82）ng／L，保护组（85．12±20．68）ng／L]，后逐渐下降，但仍高于CPB前，肺保护组增高更显著（P〈0．05）。CPB开始后，两组A—aD02和RI进行性增加（A—aD02对照组195．8±72．5，保护组161．3±33．2；RI对照组0．72±0．05，保护组0．56±0．08）；对照组T3、T4、T5的A—aDO2及RI明显高于肺保护组（P〈0．01）。结论CPB术后存在肺损伤，低温肺保护液可以抑制炎症因子TNF-α的产生，上调抗炎因子IL-10的释放，减轻肺损伤，改善术后肺功能。

Objective To investigate the protective effect of hypothermic protective solution on lungs in eardiopulmonary bypass（CPB ） patients. Methods 30 patients with congenital heart disease and severe pulmonary hypertension were divided into the control group（n= 15） and the protective group（n= 15）. The patients in the control group were performed using routine techniques, and in the protective group patients pulmonary artery were infused with 4 ℃ protective solution during CPB. Blood samples were drawn from radial artery before induetion（T1）, 30 min following clamping（T2）, 1 h after CPB（T3）, 24 h after CPB（T4） and 36 h after CPB（T5）. Tumor necrosis factor-α（TNF-α）,interleukin-10（IL-10） were measured by ELISA perioperatively in both group. Alveolar-arterial oxygen gradient A-aDO2 and Respiratory indexes （RI） were recorded at T1,T3,T4,Ts. Results There were no differences in the values of TNF-α, IL-10, A-aDo2 and RI at T1 （base value） between the two group. After CPB, the levels of TNF-α,IL-10 increased compared with the T1 in both group. The plasma levels of TNF-α in th protective group were significantly lower than the control group （P〈0.01）. The plasma levels of IL-10 in the protective group were significantly higher than the control group （P〈0.05）. Compared with the control group, protective group showed lower RI and lower A-aDO2 after operation（P〈0.01 ）. Conclusion Lung injury exists after t he surgery by CPB. The hypothermic protective solution could significandy inhibit the inflammatory cytokine TNF-α release and significantly increase the anti-inflammatory eytokine IL-10 release, and could protect lungs during eardiopulmonary bypass.