体外循环；_灌注；_肺损伤；_氧合血____

体外循环肺动脉持续灌注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,,体外循环；,灌注；,肺损伤；,氧合血,1资料与方法,2结果,3讨论,参考文献:

     摘要: 目的: 探讨体外循环期间持续肺动脉灌注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，随机分为持续肺动脉灌注含氧血的灌注组和对照组,各15例。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；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6(IL6)、白细胞介素8(IL8)、白细胞介素10(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：术后灌注组呼吸指数明显低于对照组，灌注组血浆中TNFα、IL6、IL8、MDA、LPO、sPselectin、sICAM1的表达较低，IL10表达较高，灌注组肺组织病理变化较对照组轻。结论: 体外循环期间肺动脉持续灌注含氧血可减轻肺损伤。

    关键词：体外循环；灌注；肺损伤；氧合血

    Effect of continuous pulmonary artery perfusion with oxygenated blood on lung

    vascular endothelial cell injury during cardiopulmonary bypass

    YU Xiangyou, QIAO Jun, ZHONG Hua, et al

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

    Abstract: Objective: To study the effect of continuous pulmonary artery perfusion with oxygenated blood on lung vascular endothelial cell injury during cardiopulmonary bypass(CPB). Methods: Thirty cases undergoing mitral valve replacement were randomly divided into 2 groups: group Ⅰ, as control (n=15); group Ⅱ, receiving lung perfusion (n=15). The cases in group Ⅰ were performed the routine procedure of mitral valvre placement. The cases in group Ⅱ were perfused with oxygenated blood 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 group Ⅱ 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 groupⅠ. Conclusion: Continuous pulmonary artery perfusion with oxygenated blood during CPB demonstrates the protection effect of lung vascular endothelial cell. ......

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