氟比洛芬酯对心脏瓣膜置换术患者IL-10及SP-A的影响

Effects of flurbiprofen on IL-10 and SP-A in cardiac valve replacement patients

目的探讨氟比洛芬酯(FA)对心脏瓣膜置换术患者白介素-10(IL-10)及肺表面活性物质相关蛋白A(SP-A)的影响。方法选择风心病瓣膜置换术患者40例,随机均分为2组:实验组在麻醉诱导前静脉注射FA 1 mg/kg;对照组在麻醉诱导前静脉注射等剂量的生理盐水(0.1 ml/kg)。分别于麻醉诱导前(T0)、主动脉阻断前5 min(T1)、主动脉开放后5 min(T2)、体外循环(CPB)结束后30 min(T3)、2 h(T4)、24 h(T5)抽取动脉血5 ml,测动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、血氧饱和度(SaO2),计算肺泡动脉氧分压差(A-aDO2)、氧合指数(OI)、呼吸指数(RI),同时检测血清SP-A及IL-10水平。结果两组患者性别、年龄、体重、术前左室射血分数(EF值)、心功能分级、转流时间、主动脉阻断时间、手术时间、术中最低温度的变化差异均无统计学意义,实验组机械通气时间低于对照组(P<0.05),实验组A-aDO2、RI在T4明显低于对照组(P<0.05),实验组OI在T3、T4明显高于对照组(P<0.01),CPB开始后,两组患者血清SP-A、IL-10均进行性升高,在T2达高峰,后逐渐下降,但均高于同组T0水平(P<0.05)。实验组SP-A在T2、T3、T4明显低于对照组(P<0.05),而实验组IL-10在T2、T3、T4则明显高于对照组(P<0.05)。结论 FA可以缩短机械通气时间,改善CPB后肺换气及氧合功能,并可降低血清SP-A水平、提高血清IL-10水平,提示其在抑制全身炎性反应的同时,可能降低了CPB后肺毛细血管通透性,平衡细胞因子和抑制过度应激反应,对保护肺功能有一定的作用。

Objective To investigate the effects of flurbiprofen （FA） on interleukin-10 （IL-10） and pulmonary surfaetant-assoeiated protein A （SP-A） in cardiac valve replacement patients. Methods Forty patients undergoing cardiac valve replacements were divided into control group and observation group randomly with 20 each. Patients in observation group were given FA 1 mg/kg before induction of anesthesia; patients in control group were given the same-volume saline instead. The arterial blood samples of 5 ml each were taken for measured arterial oxygen （PaO2）, arterial carbon dioxide partial pressure （PaCO2 ）, oxygen saturation （SaO2 ）, then calculated the alveolararterial oxygen difference （A-aDO2）, oxygen composite index （O1） and respiratory index （RI） before induction of anesthesia （T0）, at 5 min before aortic cross clamp （T1）, at 5 min after aortic open （T2）, at 30 min （T3）, 2 h （T4） and 24 h （T5）after cardiopulmonary bypass （CPB）, while serum concentrations of SP-A and IL-10 were analyzed and compared. Results Compared with control group, the time of duration of mechanical ventilation in observation group was shorter （P 〈 0. 05 ）. Compared with control group, A-aDO2 and RI in observation group were decreased at T4 （P 〈0. 05）, OI in observation group at T3 and T4 was increased significantly （P 〈0. 01 ）. As CPB started, serum concentrations of SP-A and IL-10 in two groups were progressively increased, and peaked at T2, then gradually decreased. Compared with TO, serum concentrations of SP-A and IL-10 were increased obviously from T1 to T5 in both groups （P 〈 0.05 ）. Compared with control group, serum concentration of SP-A in observation group was decreased from T2 to T4 （ P 〈 0.05 ）, while serum concentration of IL-10 in observation group was increased from T2 to T4 （P 〈 0. 05 ）. Conclusion FA can shorten the time of duration of mechanical ventilation, improve pulmonary ventilation and oxygenation after CPB. It can also decrease serum concentration of SP-A, increase serum concentration of IL-10. FA can decrease inflammatory response, reduce post-CPB pulmonary capillary permeability, balance the cytokines and curb excessive stress response,which may be play a protective role for the lung injury.