腺苷预适应对体外循环中未成熟肺损伤的影响

Effect of adenosine preconditioning on immature lung injury during cardiopulmonary bypass

目的研究腺苷预适应对体外循环中未成熟肺损伤的影响。方法选取2011年1月—2015年9月在河北工程大学附属医院行体外循环下先天性心脏病手术的60例患儿,随机分为对照组和腺苷预处理组,各30例。腺苷预处理组在麻醉诱导后经颈静脉留置管由微量泵给予腺苷,对照组给予等量0.9%氯化钠溶液泵入。分别于体外循环前(T_1)、体外循环开始40min(T_2)、体外循环停机(T_3)、停机后2h(T_4)、停机后6h(T_5)和停机后24h(T_6)6个不同时间点测定中性粒细胞计数、血浆中可溶性细胞黏附因子-1(s ICAM-1)与白介素8(IL-8)、肿瘤坏死因子α(TNF-α)水平。体外循环开始前及结束时取左右心房血测定中性粒细胞计数,计算中性粒细胞跨肺比值。结果中性粒细胞计数、TNF-α、s ICAM-1、IL-8均有交互作用,差异有统计学意义(P<0.05),中性粒细胞计数、TNF-α、s ICAM-1、IL-8时间间比较,差异有统计学意义(P<0.05),中性粒细胞计数、TNF-α、s ICAM-1、IL-8组间比较,差异有统计学意义(P<0.05);两组患儿外周血中性粒细胞计数、s ICAM-1、IL-8在T_2、T_3、T_4、T_5、T_6比较,差异有统计学意义(P<0.05),TNF-α在T_2、T_4、T_5、T_6比较,差异有统计学意义(P<0.05)。两组患儿体外循环时间、主动脉阻断时间比较,差异无统计学意义(P>0.05)。两组患儿中性粒细胞跨肺差值在体外循环停机时比较,差异有统计学意义(P<0.01)。结论腺苷能通过降低血中s ICAM-1、TNF-α、IL-8水平,减少中性粒细胞在肺内扣押程度,从而减轻体外循环对未成熟肺的损伤。

Objective To study the effect of adenosine preconditioning on immature lung injury during cardiopulmonary bypass. Methods From January 2011 to September 2015 in Affiliated Hospital of Hebei University of Engineering 60 children with congenital heart disease undergoing surgery under cardiopulmonary bypass were selected,they were randomly divided into control group and adenosine preconditioning group,30 cases in each group. The adenosine preconditioning group were treated with adenosine by the indwelling catheter in the jugular vein after anesthesia,the control group were perfused with the same volume of 0. 9% sodium chloride solution. Respectively before cardiopulmonary bypass( T1),cardiopulmonary bypass 40 minutes( T2),cardiopulmonary bypass shutdown( T3),2 hours after downtime( T4),6 hours after downtime( T5) and 24 hours after downtime( T6) at six different time points polymorphonuclear cell count and plasma soluble cell adhesion molecules- 1( s ICAM- 1) and interleukin- 8( IL- 8),tumor necrosis factor- α( TNF- α) levels were detected. The left and right heart atrial blood were drawed respectively before and after the cardiopulmonary bypass,the value of neutrophils of the blood was determined and the transpulmonary ratio of neutrophils was calculated. Results Polymorphonuclear cell count,TNF- α,s ICAM- 1,IL- 8 all had reciprocal action,the differences were statistically significant( P < 0. 05),comparison between time of polymorphonuclear cell count,TNF- α,s ICAM- 1,IL- 8,the differences were statistically significant( P < 0. 05),comparison among groups of polymorphonuclear cell count,TNF- α,s ICAM- 1,IL- 8,the differences were statistically significant( P < 0. 05); in the two groups,polymorphonuclear cell count,s ICAM- 1,IL- 8 at T2,T3,T4,T5,T6 time points showed significant differences( P < 0. 05),TNF- α at T2,T4,T5,T6 time points showed significant differences( P < 0. 05). Extracorporeal circulation time,aorta blocking time between the two groups showed no significant differences( P > 0. 05). Neutrophils across lung difference in cardiopulmonary bypass downtime showed significant differences( P < 0. 05). Conclusion Adenosine can attenuate the acute lung injury of immature infants during cardiopulmonary bypass,and reduce the degree of potassium in the lungs through reducing the level of s ICAM- 1,TNF- α and IL- 8 in the blood.