羟乙基淀粉对体外循环后急性肺损伤血管外肺水的影响

Effect of hydroxylethyl starch on extravascular lung water in acute lung injury after cardiopulmonary bypass

目的：探讨羟乙基淀粉对体外循环（cardiopulmonary bypass,CPB）后急性肺损伤（acute lung injury,ALI）治疗作用机制。方法：将在CPB下行心脏手术后出现ALI患者40例,随机分为治疗组20例与对照组20例。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CVP水平在8-12 mmHg。放置PiCCO导管,测定心输出量指数（cardiac output in-dex,CI）、全心舒张末期容积（global end-diastolic volume,GEDV）、血管外肺水（extravascular lung water,EVLW）及每搏输出量变异度（stroke volume variation,SVV）改变。动脉血气分析观察氧合指数（PaO2/FiO2）。结果 ：对照组与治疗组在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6 h EVLW较0 h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）。EVLW在治疗组6 h为（6.1±1.4）ml/kg,明显低于对照组6 h（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）。经过治疗后,两组氧合指数均显著升高（P〈0.05）,治疗组6 h氧合指数较对照组明显升高（P〈0.05）。对照组及治疗组GEDV在0 h为（644±83）ml/m2及（652±103）ml/m2,差异无统计学意义（P〉0.05）。经过治疗后,对照组6 h GEDV较0 h显著升高（P〈0.05）,而治疗组3、6 h GEDV均较0 h明显升高（P〈0.05）。GEDV在治疗组3、6 h均显著高于对照组水平（P〈0.05）。对照组及治疗组SVV在0 h为（13.6±3.4）%及（13.4±3.6）%,差异无统计学意义（P〉0.05）。经过治疗后,对照组6 h SVV较0 h及3 h均显著降低（P〈0.05）;而治疗组3、6 h SVV均较0 h明显降低（P〈0.05）,治疗组6 h SVV较3 h进一步下降（P〈0.05）。SVV在治疗组3h显著高于对照组3 h水平（P〈0.05）。结论：对于CPB后急性肺损伤,羟乙基淀粉可降低EVLW,改善氧合,改善肺损伤症状。

Objective：To study the reaction mechanism of hydroxylethyl starch（HES） on treating acute lung injury（ALI） after cardiopulmonary bypass（CPB）.Methods：40 ALI patients after cardiac operation under CPB were randomly divided into the treatment group（20 cases） and the control group（20 cases）.The treatment group received continuously transfusion of hydroxylethyl starch（6% voluven） and the control group was transfused with compound sodium chloride.The central venous pressure（CVP） was maintained within 8-12mmHg in 6 h and PiCCO catheter was placed.Extravascular lung water（EVLW）,cardiac output index（CI）,global end-diastolic volume（GEDV） and stroke volume variation（SVV） were detected by single indicator thermodilution technique,PaO2/FiO2 was measured in 0,3,6 h.Results：EVLW of the control group and the HES group at 0 h were（9.0±2.0）mL/kg and（8.5±1.8）mL/kg,without significant difference between them（P〈0.05）.EVLW at 6 h was lower than that at 0 h in the control group（P〈0.05）,and EVLW at 3h,6h were lower than that at 0 h in the HES group（P〈0.05）.EVLW at 6h in the HES group（6.1±1.4）mL/kg was lower than that in control group（7.3±1.5） mL/kg.PaO2/FiO2 of the control group and the HES group at 0h were（217±46） mmHg and（221±37） mmHg respectively,showing no significant different between the two groups（P〈0.05）.PaO2/FiO2 at 3,6 h were lower than that at 0 h in two groups（P〈0.05）,which at 6h in the HES group was higher than that in the control group（P〈0.05）.GEDV at 6h was higher than 0h in the control group（P〈0.05）.GEDV at 3 h,6 h were higher than that at 0 h in the HES group（P〈0.05）.GEDV at 3h and 6h in the HES group were higher than those at 3 h and 6 h in the control group（P〈0.05）.SVV at 6 h was lower than that at 0 h and 3 h in the control group（P〈0.05）,and in the HES group SVV at 3 h and 6 h were lower than that at 0 h（P〈0.05）,SVV at 6 h was lower than that at 3 h（P〈0.05）.SVV at 3 h in the HES group was lower than that at 3 h in the control group（P〈0.05）.Conclusion：Hydroxyethyl starch could reduce EVLW and improve oxygenation and symptoms in ALI after CPB.