肺动脉灌注低温肺保护液对体外循环后肺的保护作用研究

Protective Effect of Pulmonary Artery Perfusion with Hypothermic Solution during Cardiopulmonary Bypass on Lung Function

目的探讨体外循环术中肺动脉灌注低温保护液对肺脏的保护作用。方法将27例行二尖瓣置换术或主动脉瓣置换术的患者按随机数字表法分为观察组(12例)和对照组(15例)。观察组在体外循环术中肺动脉灌注低温保护液,对照组灌注心肌停跳液。观察2组主动脉阻断时间、机械辅助通气时间、ICU监护时间、住院时间;术毕,术后6、12、24h氧合指数;术前,术毕和术后6、12、24h血浆丙二醛(MDA)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及肺组织的病理表现。结果 2组主动脉阻断时间和术前血浆MDA、IL-6、TNF-α水平比较差异无统计学意义(P>0.05)。观察组机械辅助通气时间、ICU监护时间、住院时间均较对照组短,术毕和术后6、12、24h氧合指数均明显高于对照组及血浆MDA、IL-6、TNF-α水平均明显低于对照组(均P<0.05)。光学显微镜下显示对照组的肺组织有炎症细胞浸润,肺间质水肿,肺小血管充血、出血。肺保护组的肺组织结构基本正常,无明显中性粒细胞聚集及渗出。结论在体外循环期间肺动脉灌注低温肺保护液,可明显减轻肺损伤,并对肺具有保护作用。

Objective To investigate the protective effect of pulmonary artery perfusion with hypothermic solution during cardiopulmonary bypass(CPB)on lung function.Methods Twenty-seven patients undergoing mitral or aortic valve replacement were randomly assigned to receive pulmonary artery perfusion with either hypothermic protective solution(observation group,n=12)or cardioplegic solution(control group,n=15).Aortic clamp time,mechanical ventilation duration,ICU stay and hospital stay were recorded in both groups.Furthermore,oxygenation index was monitored at the end of surgery and 6,12 and 24 hours after surgery.Plasma levels of malondialdehyde(MDA),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were examined before surgery,at the end of surgery,and 6,12 and 24 hours after surgery.Moreover,pathological changes of lung tissue were observed.Results There were no significant differences in aortic clamp time and preoperative MDA,IL-6 and TNF-αlevels between the two groups(P>0.05).Compared with control group,pulmonary artery perfusion with hypothermic solution shortened mechanical ventilation duration,ICU stay and hospital stay,increased oxygenation index,and decreased plasma MDA,IL-6 and TNF-αlevels.Optical microscopy showed inflammatory cell infiltration,pulmonary interstitial edema and small blood vessel hyperemia and hemorrhage in control group.However,pulmonary structure was normal and no obvious neutrophil aggregation and exudation occurred in observation group.Conclusion Pulmonary artery perfusion with hypothermic protective solution during CPB can attenuate lung injury and has a protective effect on lung function.