抑肽酶对体外循环呼吸指数和胸肺顺应性的影响

The influence of aprotinin on respiratory index and lung-thorax compliance during cardiopulmonary bypass

目的 探讨抑肽酶是否减轻体外循环 (CPB)所致急性肺损伤。 方法 2 8例首次心脏瓣膜置换术患者随机分为对照组及抑肽酶组 ,各 14例。于CPB前 (T1)、主动脉开放后 10min(T2 )、CPB结束后 10min(T3)、6 0min(T4)监测胸肺顺应性 (Cs)和动态肺顺应性 (Cd) ,同步监测吸入气氧浓度 (FiO2 )、大气压 (PB)、PaO2 、PaCO2 ,计算呼吸指数 (RI)。 结果 对照组Cs、Cd和RI在T1(5 6 43±9 2 9,45 6 2± 6 92 ,0 45± 0 13)与抑肽酶组 (5 2 8± 13 49,42 97± 9 0 6 ,0 44± 0 10 )差异无显著性意义 (P >0 0 5 ) ,Cs、Cd在T2 (33 82± 8 83,2 8 39± 6 0 4)、T3(35 42± 11 83,30 6 1± 7 88)、T4(37 96±7 2 7,32 38± 6 5 2 )较T1及同时间点的抑肽酶组 (42 74± 9 0 8,36 83± 5 47;43 38± 10 88,37 2 7±10 5 7;47 6 4± 12 2 7,40 5 2± 9 0 7)明显下降 (P <0 0 5 )。对照组RI在T2 (0 78± 0 14) ,T3(0 6 9±0 12 )较T1及同时间点抑肽酶组 (0 5 3± 0 14,0 5 1± 0 1)明显升高 (P <0 0 5 ) ,T4(0 6 3± 0 13)与T1无明显差异但仍高于抑肽酶组 (0 49± 0 13)。 结论 抑肽酶可减轻CPB所致急性肺损伤。

Objective To study the projecti on effect of aprotinin on acute lung injury during cardiopulmonary bypass (CPB ). Methods Twenty eight patients scheduled fo r cardiac value replacement for the first time were randomized into two groups: control group (14 patients) and aprotinin treatment group (14). Pulmonary thoracic compliance (Cs) and dynamic compliance (Cd) were measured at pre CPB( T1), 10 minutes after aortic crossclamping (T2), and 10 minutes (T3), 60 minutes (T4) after CPB. Arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide(PaCO 2), fractional concentration of oxygen in inspi red gas (FiO2), and barometric pressure (PB) were measured at the same time. The n respiratory indexes (RI) were calculated. Results There were no differences in the values of Cs,Cd and RI at T1 between the aprotinin group(52 8±13 49, 42 97±9 06, 0 44±0 1) and the control g roup (56 43±9 29,45 62±6 92,0 45±0 13) respectively( P >0 05).Ther e was a significant ( P <0 05) decrease of Cs and Cd at T2 (33 82±8 83, 28 39±6 04), T3(35 42±11 83,30 6±17 88) and T4(37 96±7 27,32 38±6 52) in the control group as compared with basline values (T1)and the values of the aprotinin group (42 74±9 08,36 83±5 47; 43 38±10 88 , 37 27±10 57; 47 64±12 27, 40 52±9 07) respectively. The RI of the control group at T2 (0 78±0 14), T3(0 69±0 12) was higher than either their baseline(T1) or the values of the aprotinin group (0 53±0 14, 0 51±0 1) at the same measu re points ( P <0 05). Though there was no difference( P >0 05) between T4(0 63±0 13) and their baseline′s in the control group, the values of the control group were higher than those of the aprotinin group at T4(0 49±0 13)( P <0 05). Conclusion Aprotinin has a pro tection effect on acute lung injury after CPB.