含3种药物氧合温血肺动脉持续灌注对体外循环肺损伤的临床对比研.docVIP

　　含3种药物氧合温血肺动脉持续灌注对体外循环肺损伤的临床对比研 艾克拜尔买买提 单雪峰, 木拉提阿布都热合曼 【摘要】 目的观察体外循环(CPB)期间肺动脉持续灌注氧合血及L?精氨酸、甲泼尼龙、川穹嗪3种药物加机械通气对肺损伤的保护作用。方法选择60例择期常规行二尖瓣置换术病人，采用临床对照研究。随机分成4组：对照组采用肺动脉持续灌注氧合血加机械通气，余各加药组在对照组基础上分别加入L?精氨酸、甲泼尼龙和川穹嗪，每组各15例。4组病人均采用常规CPB，分别在麻醉后、开放主动脉1 h，回ICU 0、6、12、24 h取桡动脉血，测定肿瘤坏死因子(TNF?alpha;)、 白细胞介素6(IL?6)和白细胞介素10(IL?10)的表达。结果60例患者术中及术后经过顺利，均痊愈出院。开放主动脉后，各加药组血浆TNF?alpha;、IL?6水平均明显低于对照组，而IL?10水平明显高于对照组,差异有统计学意义(Plt;0.05)。结论在CPB过程中持续肺动脉灌注L?精氨酸、川穹嗪、甲泼尼龙均可以明显抑制炎症因子的合成与释放，增加抗炎因子的释放，具有肺保护作用。 【关键词】 体外循环; 肺损伤; L?精氨酸; 川穹嗪; 甲泼尼龙; 氧合血 　Clinical study on the effect of continuous pulmonary artery perfusion blood contain three different drugs on lung injury during cardiopulmonary bypass 　　AikebaierMaimaiti, SHAN Xue?feng, MulatiAbudureheman 　　(Department of Cardiosurgical, First Affiliated Hospital, Xinjiang Medical Universityt, 　　Urumqi 830011, China) 　　Abstract ObjectiveTo evaluate the protective effect of continuous pulmonary artery perfusion ethylprednisolone ligustrazine plus mechanical ventilation on lung ischemia reperfusion injury during cardiopulmonary bypass(CPB) extracorporeal circulation. Methods60 cases patients scheduled for mitral valve replacement ized into 4 groups:Ⅰ, CPB onary artery perfusion Blood plus mechanical ventilation (control group, n=15); Test group:, mechanical ventilation (n=15) plus continuous pulmonary artery perfusion ethylprednisolone ( group Ⅲ, n=15) or containing ligustrazine (group Ⅳ, n=15). All 4 groups received routine procedure of CPB.Blood samples the radial artery at the folloe points: after anaesthesia,1 hours after opening of aorta, being taken back to ICU 0, 6, 12, 24 hours. The expression of tumor necrosis factor?alpha; (TNF?alpha;), interleukin?6 (IL?6) and interleukin?10 (IL?10) oothly.TNF?alpha; and IL?6 level in group onary bypass, continuous pulmonary artery perfusion matory factor and induce anti?inflamatory factor, may play protective role on lung than control group. 　　Key onary bypass; lung injury; pulmonary artery perfusion; L?a