甲基强的松龙预先给药对体外循环诱发心脏手术患者肠粘膜屏障损伤的影响

Effect of methylprednisolone pretreatment on cardiopulmonary bypass-induced intestinal barrier injury in patients undergoing cardiac surgery

目的评价甲基强的松龙预先给药对体外循环（CPB）诱发心脏手术患者肠粘膜屏障损伤的影响。方法择期心脏手术患者90例，年龄30～50岁，性别不限，体重50～75kg，心功能分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为3组（n=30）：非CPB对照组（I组）、CPB对照组（Ⅱ组）和CPB甲基强的松龙组（Ⅲ组）。Ⅲ组于手术开始前和CPB开始前分别静脉注射甲基强的松龙10mg／kg，Ⅰ组和Ⅱ组静脉注射等量生理盐水。于麻醉诱导前（TI）、CPB开始前（T2）、CPB30min（L）、CPB结束后30min（T4）、术后120min（B）时采集中心静脉血样测定血浆内毒素浓度；记录术后7d内感染发生情况。结果3组T1时血浆内毒素浓度比较差异无统计学意义，且均在正常范围；与Ⅰ组比较，Ⅲ组T3、T4和T5时血浆内毒素浓度升高，术后感染发生率升高（P〈0．05）；与Ⅱ组比较，Ⅲ组T3、T4和T5时血浆内毒素浓度降低，术后感染发生率降低（P〈0．05）。结论甲基强的松龙预先给药可减轻心脏手术患者CPB所致的肠粘膜屏障功能损害。

Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass （CPB）-induced intestinal barrier injury in patients undergoing cardiac surgery. Methods Ninety NYHA Ⅰ or Ⅱ patients, aged 30-50 yr, weighing 50-75 kg, scheduled for elective cardiac surgery with CPB, were randomly divided into 3 groups （ n = 30 each） ： control group without CPB （group Ⅰ） , control group with CPB （group n ） and administration of methylprednisolone before CPB group （ group Ⅲ） . Anesthesia was induced with midazo- lam, fentanyl, etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium. The patients were mechanically ventilated after tracheal intubation. In group Ⅲ , methylprednisolone 10 mg/kg was injected intravenously before operation and CPB. While in groups Ⅰ and Ⅱ , the equal volume of normal saline was injected instead. The blood samples were taken from the central vein before induction of anesthesia （T1） , before CPB （T5 ）, at 30 min after the beginning of CPB （T3）, at 30 rain after the end of CPB （T4） and at 120 min after operation （T5 ） for determination of the plasma endotoxin concentration. Infection was recorded within 7 days after operation. Results The plasma endotoxin concentrations at TI were within the normal range in all groups, without significant difference among the three groups （ P 〉 0.05） . The plasma endotoxin concentration at T35 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ , while higher than those in group I （ P 〈 0.05）. Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal barrier function in patients undergoing cardiac surgery.