远程缺血预处理对全胸腔镜体外循环手术的肺保护作用

Lung protective effect of remote ischemic preconditioning on totally tho-racoscopic cardiac surgery with cardiopulmonary bypass

目的探讨直接阻断股动脉进行下肢缺血预处理对全胸腔镜体外循环手术患者术后肺功能的影响。方法选取2015年3月～2016年5月在本院实施胸腔镜下体外循环手术的60例先天性心脏病患者作为研究对象，随机分为研究组（R组）和对照组（c组），各30例。游离股动、静脉后，c组直接插管建立体外循环；R组夹闭股动脉3min，开放3min，如此三个循环后与c组采用相同的方法建立体外循环。两组均采用右侧胸壁三孔入路，在第三、四和六肋间切取三个1．5～2．0cm的孔状切口，在胸腔镜下显露术野完成手术。于麻醉诱导插管完毕5min（T0）、体外循环停机2h（T1）、体外循环停机12h（T2）和体外循环停机24h（T3）采集桡动脉血进行血气分析，记录氧合指数；采集外周静脉血以酶联免疫吸附法（ELISA）检测血浆可溶性晚期糖基化终末产物受体（RAGE）含量。结果60例患者均治愈出院，两组术后的机械通气时间比较，差异无统计学意义（P〉0．05）。两组T0时的氧合指数比较，差异无统计学意义（P〉0．05）。两组T广T3时的氧合指数均降低，R组T1～T3时的氧合指数高于C组同时间段，差异有统计学意义（P〈0．05）。两组R时的血浆RAGE水平比较，差异无统计学意义（P〉0．05）。两组T1～T3时的血浆RAGE水平均增高，R组T1-T3时的血浆RAGE水平显著低于C组同时间段，差异有统计学意义（P〈0．05）。结论直接阻断股动脉进行下肢缺血预处理，可减轻全胸腔镜体外循环手术肺损伤程度，具有一定肺功能保护作用。

Objective To investigate the effects of remote ischemic preconditioning （RIPC） by direct femoral artery occlusion on lung function of patients undergoing totally thoracoscopic cardiac surgery with eardiopulmonary bypass（CPB）. Methods 60 patients with congenital heart disease underwent thoracoscopic cardiac surgery with CPB from March 2015 to May 2016 were selected and divided into the research group （group R） and the control group （group C）,30 cases in each group.After the femoral artery and vein were dissociated,group C was established CPB through the intubation directly.Group R was clamped and closed femoral artery 3 min,then open 3 min,After three cycles,the same method in the group C was used to establish CPB.Through three hole shape incision at the right chest wall,that each was 1.5 to 2.0 cm long in the third, fourth and sixth intercostals surgical field was revealed totally by thoracoscope to complete the operation.The radial artery blood was collected after tracheal intubation for 5 min （T0）,after cessation of CPB for 2 hours （TO, after cessation of CPB 12 hours （T2） and after cessation of CPB 24 hours（T3）.Oxygenation index was recorded by blood gas analysis.The receptor of advanced glycation end-products （RAGE） level was detected by enzyme linked immunosorbent assay （ELISA）.Results 60 patients were all cured.There was no significant difference in the mechanical ventilation time between the two groups （P〉0.05）.There was no significant difference in oxygenation index between the two groups in To point （P〉0.05）.The oxygenation index of the two groups of T1-T3 were all decreased.The oxygenation index of group R in T1-T3 points was higher than that of group C at the same time,with significant difference （P〈0.05）.There was no significant difference in the level of RAGE between the two groups in To point （P〉0.05）.The level of plasma RAGE were increased in the two groups in T1-T3 points.The level of plasma RAGE of group R in T1-T3 points was lower than that of group C at the same time,with significant difference （P〈0.05）.Conclusion RIPC by femoral artery occlusion can decrease the level of RAGE in patients underwent thoraco-scopic cardiac surgery with CPB and has lung protective ef-fects.