体外循环后的肺损伤及其炎症反应

Lung injury and systemic inflammatory response after extracorporeal circulation

目的 探讨体外循环引起的全身炎症反应和肺损伤间的相互关系。方法 32例先天性心脏病合并肺动脉高压病人 ,测定体外循环前后呼吸生理变化、白细胞计数、白介素 (IL) 6、IL 8、脂质过氧化物和血栓素、6 酮 PGFlα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 ,P <0 0 5。白细胞计数、IL 6、IL 8、脂质过氧化物和血栓素、6 酮 PGFlα在体外循环后显著升高 ,P <0 0 1,其中IL 8与肺顺应性呈负相关 ,r =- 0 34 0 ,P <0 0 5 ;6 酮 PGF1α与肺顺应性呈正相关 ,r=0 417,P <0 0 5。结论 体外循环后引起全身炎症反应和肺损伤 ,肺损伤程度与IL 8呈正相关 ,与 6 酮 PGF1α呈负相关。对先天性心脏病合并肺动脉高压的病人 ,体外循环中使用前列环素或前列腺素E1能减轻肺损伤。

Objective: To study cardiopulmonary bypass (CPB) induced systemic inflammatory response and lung injury, and to evaluate their relationship. Method: 32 cases of congenital heart disease with pulmonary hypertension were studied. Lung compliance, inspiratory and expiratory resistance, airway peak pressure and plateau pressure, WBC count, interleukin 6, interleukin 8, lipid peroxide, thromboxane B2, 6 keto PGF 1α were assessed before and after CPB. Result: After CPB, lung compliance decreased significantly (P<0.05). Inspiratory and expiratory resistance, peak pressure and plateau pressure, WBC count, interleukin 6, interleukin 8, lipid peroxide, thromboxane B2, 6 keto PGF 1α increased significantly (P<0.01). Interleukin 8 had negative relationship with lung compliance (R=-0.3400, P<0.05), 6 keto PGF 1α had positive relationship with lung compliance (R=0.417, P< 0.05 ). Conclusion: CPB can induce systemic inflammatory response and lung injury. Lung injury had positive relationship with interleukin 8, and negative relationship with 6 keto PGF 1α .