肢体远隔缺血预处理对胸腔镜体外循环心脏手术中肺损伤的保护作用

Protective effect of limb remote ischemic preconditioning on lung injury during extracorporeal circulation in thoracoscopic cardiac operation

目的探讨肢体远隔缺血预处理后对胸腔镜体外循环心脏手术中肺损伤的保护机制。方法选择2010年1月至2013年8月于郑州市第七人民医院行胸腔镜体外循环心脏手术患者60例,其中30例于体外循环前进行远隔缺血预处理(观察组),另30例不进行远隔缺血预处理(对照组),比较2组患者体外循环时间、手术时间、心肌血运阻断时间、术后机械通气时间及重症监护时间,分别于手术前及手术后6、24 h检测2组患者桡动脉血的氧合指数(OI),采用酶联免疫吸附测定法测定血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)水平,化学比色法测定血清丙二醛(MDA)水平。结果 2组患者手术时间、体外循环时间、心肌血运阻断时间、重症监护时间比较差异均无统计学意义(P>0.05),但观察组患者术后机械通气时间显著短于对照组(P<0.05)。2组患者手术前OI及血清TNF-α、IL-6、MDA水平比较差异均无统计学意义(P>0.05);2组患者手术后6、24 h血清TNF-α、IL-6及MDA水平均显著高于手术前(P<0.05),而OI显著低于手术前(P<0.05)。观察组患者手术后6、24 h血清TNF-α、IL-6及MDA水平显著低于对照组(P<0.05),而OI显著高于对照组(P<0.05)。结论肢体远隔缺血预处理对胸腔镜体外循环心脏手术中肺损伤具有保护作用。

Objective To investigate the protective mechanism of limb remote ischemic postconditioning on the injury of lung during extracorporeal circulation in thoracoscopic cardiac operation. Methods Sixty patients who underwent thoracoscopic cardiac operation under extracorporeal circulation were selected in the Seventh People＇s Hospital of Zhengzhou City from January 2010 to August2013. Among the patients,thirty patients were performed with limb remote ischemic postconditioning before extracorporeal circulation（ observation group）,but the other 30 patients without remote ischemic preconditioning（ control group）. The extracorporeal circulation time,operation time,myocardial devascularization time,postoperative mechanical ventilation time and intensive care time were compared between the two groups. The oxygenation index（ OI） of radial artery were detected at the time points of before operation and 6,24 hours after operation in the two groups. The levels of serum tumor necrosis factor-α（ TNF-α） and interleukin-6（ IL-6） were detected by enzyme-linked immunosorbent assay. The serum malondialdehyde level was detected by chemical colorimetric method. Results There was no significant difference in the operation time,extracorporeal circulation time,myocardial devascularization time and intensive care time between the two groups（ P〉0. 05）. But postoperative mechanical ventilation time in observation group was significantly shorter than that in control group（ P〈0. 05）. There was no significant difference in level of TNF-α,IL-6,MDA and OI between the two groups before treatment（ P〉0. 05）. Compared with before treatment,the levels of TNF-α,IL-6 and MDA were significantly higher（ P〈0. 05）,but the OI was significantly lower at 6 and 24 hours after operation（ P〈0. 05）. Six and twenty-four hours after operation,the levels of TNF-α,IL-6 and MDA in observation group were significantly lower than those in control group（ P〈0. 05）,but the OI in observation group was significantly higher than that in control group（ P〈0. 05）. Conclusion Limb remote ischemic postconditioning has the protective effect on the injury of lung during extracorporeal circulation in thoracoscopic cardiac operation.