丙泊酚对体外循环中致炎细胞因子IL-8及呼吸指数影响的临床研究

Clinical study on the effects of propofol on the proinflammatory cytokine IL-8 and respiratory index during cardiopulmonary bypass

目的 观察丙泊酚对体外循环 (CPB)中致炎细胞因子白细胞介素 8(IL 8)及呼吸指数 (RI)的影响 ,探讨致炎细胞因子IL 8在CPB相关急性肺损伤中的意义及丙泊酚保护作用的机制。方法 选取ASAⅡ～Ⅲ级 ,风湿性心脏瓣膜患者 2 0例。随机分成两组 :丙泊酚组和对照组 (每组 10例 )。除丙泊酚组在麻醉诱导和维持中加用丙泊酚外 ,其它术中用药两组均相同。两组分别于麻醉诱导后CBP前 (T1) ,主动脉阻断后 30min(T2 ) ,主动脉开放后 10min(T3 ) ,30min(T4) ,2h(T5) ,4h(T6) ,6h(T7)分别采集肝素抗凝桡动脉血检测动脉血浆丙二醛 (MDA) ,IL 8的含量和呼吸指数。结果 两组T3 ～T7RI ,MDA及IL 8均明显升高 (P <0 .0 5 ) ;两组RI ,MDA和IL 8在T5达峰值 ;T3 ～T7丙泊酚组RI,MDA和IL 8显著低于对照组 (P <0 .0 5 ) ;两组血浆IL 8与MDA ,IL 8与RI及MDA与RI的关系在T5时间点呈正相关。结论 丙泊酚通过抑制致炎细胞因子IL 8的产生 ,有效地平抑组织炎症反应 。

OBJECTIVE: To observe the effects of propofol on the proinflammatory cytokines interleukin-8 (IL-8) and respiratory index (RI) during cardiopulmonary bypass (CPB) and inquire into the significance of IL-8 in acute lung injury (ALI) correlated with CPB and the mechanism of propofol's protective action. METHODS: Twenty patients with rheumatic heart valvular disease whose ASA scale was II ∼ III, aortic clamping time and bypass time were more than 40,60 minutes (min) respectively were Elected and divided randomly into two groups (n = 10 each): control group and propofol group. There were no differences between two groups about medication during operation except that the propofol was used for anesthesia induction and maintenance in propofol group. Blood samples from radial artery were taken after anesthesia induction and before CBP(T1), 30 min after aortic clamping (T2) and 10 min (T3), 30 min (T4), 2 h(T5), 4 h(T6), 6 h(T7) after aortic declamping for determining of respiratory index (RI), arterial plasma levels of malondialdilyde (MDA) and IL-8. RESULTS Compared with those at T1 and T2, the levels of RI, MDA and IL-8 increased significantly from T3 ∼ T7, and RI, MDA and IL-8 levels reached the peak at Ts in both groups (P < 0.05). The plasma levels of ID 8 correlated positively with MDA and RI, and MDA also correlated positively with RI at Ts (P < 0.05) in both groups. CONCLUSION By decreasing the IL-8 level, propofol can attenuate CPB-induced tissue inflammatory response and lung injury effectively.