羟乙基淀粉对体外循环后急性肺损伤的治疗作用

Effect of hydroxyethyl starch on acute lung injury after cardiopulmonary bypass

目的:探讨羟乙基淀粉对体外循环(CPB)后急性肺损伤(ALI)治疗作用机制。方法:将体外循环下行心脏手术后出现ALI患者40例,随机分为治疗组(n=20)与对照组(n=20)。入室后6 h内治疗组持续予以羟乙基淀粉(6%万汶),对照组予以复方氯化钠进行输液治疗,维持中心静脉压(CVP)水平在8～12 mmHg。放置PiCCO导管用单指示剂法测定心输出量指数(cardiac output index,CI),血管外肺水指数(EVLW)。动脉血气分析观察氧合指数(PaO2/FiO2),术后抽取第0、6小时静脉血,酶联免疫吸附法测定血浆中TNF-α,IL-6的含量。结果:对照组及治疗组EVLW在0 h为(9.0±2.0)ml/kg及(8.5±1.8)ml/kg,差异无统计学意义(P>0.05)。对照组术后6 h EVLW较术后即刻显著降低(P<0.05),治疗组3、6 h EVLW均较0 h明显降低(P<0.05)。治疗组术后6 h EVLW为(6.1±1.4)ml/kg,明显低于对照组(7.3±1.5)ml/kg(P<0.05)。对照组及治疗组氧合指数在0 h为(217±46)mmHg及(221±37)mmHg,差异无统计学意义(P>0.05)。两组患者治疗后氧合指数均较治疗前明显升高(P<0.05),但6 h治疗组氧合指数明显高于对照组(P<0.05)。两组患者3、6 h血浆中TNF-α含量均较0 h显著降低(P<0.05),且治疗组6h较3 h明显降低(P<0.05);治疗组6 h TNF-α水平较对照组明显降低(P<0.05)。两组6 h血浆中IL-6含量均较0h显著降低(P<0.05),在0、3、6 h两组间IL-6水平差异无统计学意义(P>0.05)。结论:对于体外循环后急性肺损伤,羟乙基淀粉可降低EVLW,改善氧合,减轻炎症反应,改善肺损伤症状。

Objective： To determine the effect of hydroxyethyl starch on acute lung injury（ALI）after cardiopulmonary bypass（CPB）.Methods： Forty ALI patients after cardiac operation were randomly divided into two groups,patients respectively received transfusion with Ringer′s（group control,n=20） and hydroxyethyl starch（group HES,n=20）.Patients were transfused to maintain central venous pressure within 8-12 mmHg in 6 hours.Extravascular lung water（EVLW） and cardiac output index（CI） were detected by single indicator thermodilution technique,PaO2/ FiO2 and blood plasma TNF-α,IL-6 were measured in 0,3,6 h.Results： EVLW of control and HES group at 0h were（9.0±2.0）ml/kg and（8.5±1.8）ml/kg,and there was no significant difference between them（P0.05）.EVLW at 6h was lower than 0h in control group（P0.05）,and EVLW at 3h,6h were lower than 0h in HES group（P0.05）.EVLW at 6h in HES group（6.1±1.4）ml/kg was lower than EVLW at 6h in control group（7.3±1.5）ml/kg.PaO2/FiO2 of control and HES group at 0 h were（217±46）mmHg and（221±37） mmHg,there was no significant difference between two groups（P0.05）.PaO2/FiO2 at 3,6 h were lower than 0 h in two groups（P0.05）,HES group at 6h were higher than control group（P0.05）.TNF-α at 3h,6h were lower than 0h in control group（P0.05）.TNF-α at 3 h,6 h were lower than 0h in HES group（P0.05）,and TNF-α at 6 h were lower than 3 h（P0.05）.TNF-α at 6 h in HES group were lower than TNF-α at 6h in control group（P0.05）.IL-6 at 6 h were lower than 0h in control and HES group（P0.05）,and there was no significant difference between IL-6 at 0,3,6 h in two groups（P0.05）.Conclusion： Hydroxyethyl starch could reduce EVLW,degrade inflammation and raise oxygenation in ALI after CPB.