体外循环；灌注；肺损伤；氧合血；川芎嗪_

体外循环肺动脉持续灌注含川芎嗪氧合血对肺损伤保护作用的研究

http://www.100md.com 《新疆医科大学学报》 2006年第9期

体外循环；灌注；肺损伤；氧合血；川芎嗪,,体外循环；灌注；肺损伤；氧合血；川芎嗪,1资料与方法,2结果,3讨论,参考文献:

     摘要: 目的: 探讨体外循环(CPB)期间持续肺动脉灌注含川芎嗪氧合血对肺损伤的保护作用。方法: 选择30例择期行体外循环心脏瓣膜置换术的病人，随机分为灌注组和加药组，每组15例。灌注组CPB期间给予机械通气及肺动脉持续灌注氧合血；加药组给予机械通气，肺动脉灌注氧合血中加入川芎嗪5 mg/kg。分别在麻醉后、回ICU 30 min和拔除气管插管前采桡动脉血进行血气分析，计算呼吸指数(RI)；分别在麻醉后、开放主动脉1 h及回ICU 0、6、12、24 h取桡动脉血，ELISA法测定肿瘤坏死因子α(TNFα)、白细胞介素(IL6、IL8、IL10)、丙二醛(MDA)、脂质过氧化物(LPO)、可溶性P选择素(sPselectin)、可溶性细胞间粘附分子1(sICAM1)的表达；取右上肺小块肺组织(1 cm×1 cm×1 cm)进行免疫组化，观察基质金属蛋白(MMP2、MMP9)的表达。光镜、透射电镜观察肺组织结构变化。结果：术后加药组呼吸指数明显低于灌注组，加药组血浆中TNFα、IL6、IL8、MDA、LPO、sPselectin、sICAM1的表达较低，IL10表达较高，加药组肺组织病理变化较灌注组轻。结论： CPB期间肺动脉持续灌注氧合血中加入川芎嗪可明显减轻肺损伤。

    关键词：体外循环；灌注；肺损伤；氧合血；川芎嗪

    Effect of continuous pulmonary artery perfusion with oxygenated blood and

    ligustrazine on lung injury during cardiopulmonary bypass

    YU Xiangyou, QIAO Jun, ZHENG Hong, et al

    (Department of Anaesthesiology, First Affiliated Hospital, Xinjiang Medical University,Urumqi 830054, China)

    Abstract: Objective: To evaluate the protective effect of Ligustrazine on lungs from acute injury induced by CPB in order to conclude the mechanism of protective effect of Ligustrazine on lungs. Methods: Thirty cases undergoing mitral valve replacement were randomly divided into 2 groups: group Ⅰ, receiving lung perfusion (n=15); group Ⅱ, receiving Ligustrazine (n=15). The cases in group Ⅰ were perfused with oxygenated blood continuously to the pulmonary artery during CPB. The cases in group Ⅱ were perfused with oxygenated blood and Ligustrazine (5 mg/kg) continuously to the pulmonary artery during CPB. All the subjects were given mechanical ventilation before, during and after blocking the caval veins. Respiratory index (RI) was calculated before CPB, 30mins after being taken back to ICU and before extubation. Blood samples were drawn from the radial artery at the following time points: after anaesthesia, 1 hours after opening aorta, being taken back to ICU 0, 6, 12 and 24 hours. The plasma levels of tumor necrosis factorα (TNFα), interleukin6 (IL6) and interleukin8 (IL8), interleukin10 (IL10), malondialdehyde (MDA), lipid peroxidation product (LPO), soluble Pselectin (sPselectin), soluble intercellular adhesion molecule1 (sICAM1)were measured. After 30 minutes of CPB, the lung biopsies were obtained from rightlow lungs. The expression of matrix metalloproteinases2 (MMP2) and matrix metalloproteinases9 (MMP9) were measured by the immunohistochemical technigue. Results: RI in groupⅡ was lower than in group Ⅰ (P<0.05). The expression of TNFα, IL6, IL8, MDA, LPO, sPselectin, sICAM1 were lower in group Ⅱ (P<0.05), while the expression of IL10 was higher in group Ⅱ (P<0.05). The lung in group Ⅱ showed moderater injury than the ones in group Ⅰ. Conclusion: Ligustrazine can provide protective effects on lung injury induced by CPB. ......

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