吸入NO对体外循环术中肺缺血再灌注损伤的保护作用

Protective effects of low dose nitric oxide inhalation on lung ischemia/ reperfusion injury during cardiopulmonary bypass surgery

目的 :探讨吸入一氧化氮 (NO)对体外循环手术中肺缺血再灌注损伤有无保护作用。方法 :将 2 0例风湿性心脏瓣膜疾病患者随机分为对照组和NO组 ,术中观察平均肺动脉压 (MPaP)、肺动脉阻力 (PVR)、气道峰压 (PAP)、动脉血氧分压 (PaO2 )、环磷酸鸟苷 (cGMP)、细胞间粘附分子 1(ICAM 1)、黄嘌呤氧化酶 (XOD)及丙二醛含量 (MDA) ,并记录术后应用人工呼吸时间。结果 :与NO组相比 ,对照组再灌注后PAP ,MPaP ,PVR明显升高 (P <0 .0 5 ) ;肺氧合功能明显受损 ,术后使用人工呼吸机时间显著延长 (P <0 .0 1) ;cGMP明显降低 (P <0 .0 1) ,而ICAM 1,XOD及MDA明显升高 (P <0 .0 5 )。结论 :说明体外循环术中存在明显的肺缺血再灌注损伤 ,再灌注后 11min吸入 2 0ppmNO连续 30min对该损伤有明显的保护作用 ,其机制与增加cMGP ,ICAM 1及XOD活性 ,降低及灭活 /减少氧自由基生成有关。

Objective: Our aim is to study the effects of inhaleing nitric oxide(NO) on the pulmonary ischemia/reperfusion injury during cardiopulmonary bypass surgery. Methods: Cardiac valve replacement was performed on twenty patients with chronic rheumatic heart valve disease under cardiopulmonary bypass, and they were randomly divided into two groups: control group(n=10) and NO group(n=10). We monitored the following: mean pulmonary arterial pressure(MPaP), pulmonary vascular resistance(PVR), peak airway pressure(PAP), cyclic guanosine monophosphate(cGMP), inter cellular adhesion molecule 1(ICAM 1), xanthinoxidase(XOD), malondialdehyde(MDA), PaO 2 and the duration of post operative mechanical ventilation. Results: The PAP, MPaP and PVR in the control group were much higher than those in NO group after reperfusion(P<0.05). The durations of postoperative mechanical ventilation in NO group were shorter than those in the control group(P<0.01). The cGMP and PaO 2 after reperfusion in NO group were higher(P<0.01), and the ICAM 1, XOD, MDA were lower(P<0.05) than those in the control group. Conclusions: ①If aortic clamp time is over 1?h, lung ischemia/reperfusion injury may occur during cardio pulmonary bypass surgery. ②Inhaling 20 ppm NO in the early phase of reperfusion has protective effects on the lung ischemia/reperfusion injury during cardio pulmonary bypass surgery. ③The mechanisms of the protective effects may be related with the increase of cGMP and the decrease of ICAM 1, XOD, MDA. [