七氟醚缺血再灌注早期处理对体外循环中肺内激活中性粒细胞作用的研究

Effects of sevoflurane treatment on activation of neutrophils in the lungs early during ischemia-reperfusion in cardiopulmonary bypass

目的研究体外循环心脏手术中七氟醚缺血及再灌注早期处理对肺内激活中性粒细胞的作用。方法40例二尖瓣或者主动脉瓣膜置换的患者随机分为七氟醚组和对照组,每组20例。七氟醚组患者在阻断升主动脉前吸入2%七氟醚15 min,阻断后经膜式氧合器吸入2%七氟醚15 min,主动脉开放前经膜式氧合器吸入2%七氟醚15 min,开放后恢复机械通气继续吸入2%七氟醚15 min;对照组整个过程不给予任何吸入性麻醉药物。分别于体外循环前(T1)及主动脉开放后30 min(T2)抽取左右心房血样检测中性粒细胞计数和中心粒细胞表面CD11b的表达。分别于切皮前(T0)、体外循环前(T1)、主动脉开放后30 min(T2)、开放后2 h(T3)、开放后6 h(T4)、开放后24 h(T5)取桡动脉血检测动脉血气计算肺泡动脉血氧分压差P(A-a)O2、氧合指数(OI)、观察不同时间点肺功能变化。结果与T1时间点比较,2组患者在T2时间点中性粒细胞计数、CD11b水平及其跨肺前后的差值都明显升高(P<0.05)。与对照组相比,在T2时间点七氟醚组白细胞计数、CD11b水平及其跨肺前后的差值均明显降低(P<0.05)。与T0时间点比较,2组患者在T2、T3、T4、T5时间点P(A-a)O2均明显升高(P<0.05),而OI明显降低(P<0.05)。与对照组相比,在T2、T3、T4、T5时点七氟醚组P(A-a)O2明显低于对照组(P<0.05),而OI明显高于对照组(P<0.05)。结论体外循环心脏手术中应用七氟醚缺血和再灌注早期处理可以抑制白细胞的激活、黏附,改善患者的肺功能,值得临床推广应用。

Objective To investigate the effect of early treatment with sevoflurane on activating neutrophil function in lungs early during ischemia-reperfusion in cardiac surgery under cardiopulmonary bypass.Methods Forty patients who underwent mitral or aortic valve replacement were randomly divided into the sevoflurane group and control group(n=20 each).In sevoflurane group,2%sevoflurane was inhaled for 15 minutes via mechanical ventilation before aortic occlusion,15 minutes via membrane oxygenator after aortic occlusion and before aortic opening each,and more 15 minutes after aortic opening on the resumed mechanical ventilation,respectively.In the control group,no inhalation anesthetics were given during the whole process.Left and right atrial blood samples were taken before cardiopulmonary bypass(T1)and 30 minutes after aortic opening(T2)for measurement of neutrophil counts and CD11b expression on the surface of neutrophils.Radial artery blood samples were taken before skin incision(T0),before cardiopulmonary bypass(T1),30 minutes after aortic opening(T2),2 hours after aortic opening(T3),6 hours after opening(T4)and 24 hours after opening(T5)respectively to measure the arterial blood gas,calculate the pulmonary alveolar arterial oxygen partial pressure difference P(A-a)O2,and oxygenation index(OI).The changes of pulmonary function at different time points were recorded.Results Compared with T1,the neutrophil count,CDllb level and the difference in blood CD11b levels before and after entering the lungs in two groups were significantly increased at T2(P<0.05).Compared with control group,the neutrophil count,CDllb level and the difference in blood CD11b levels before and after entering the lungs in sevoflurane group at T2 were significantly lower(P<0.05).Compared with T0,the P(A-a)O2 level was increased(P<0.05),while the OI decreased significantly at T2,T3,T4 and T5 in both groups(P<0.05).Compared with control group,the P(A-a)O2 levels were significantly lower at T2,T3,T4 and T5(P<0.05),while OI was significantly higher in sevoflurane group(P<0.05).Conclusion Early sevoflurane treatment of ischemia-reperfusion may inhibit the activation and adhesion of neutrophils and improve pulmonary function in patients undergoing cardiac surgery under cardiopulmonary bypass,which justifies its widespread use in clinical settings.