体外循环术中通气策略对血浆及支气管肺泡灌洗液中炎性反应因子.doc

体外循环术中通气策略对血浆及支气管肺泡灌洗液中炎性反应因子 　 作者：何庚戌 刘俊堂 李海英 周峰 刘颖 方万香 濮仁富 【摘要】 目的 探讨体外循环(CPB)中肺持续通气对CPB引起的炎性反应的影响。方法 60例CPB下进行冠状动脉旁路移植术(CABG)的患者随机分为持续通气组和非通气组。分别在麻醉后、主动脉开放后1 h、4 h和6 h测定血浆白介素(IL)-8、IL-10、基质金属蛋白酶(MMP)-9、组织金属蛋白酶抑制剂(TIMP)-1和血栓素B2(TXB2)的水平。并在术前和主动脉开放后4 h测定支气管肺泡灌洗液中上述细胞因子的水平。结果 血浆IL-8、IL-10和MMP-9水平在主动脉开放后1 h、4 h和6 h均明显升高。在主动脉开放后4 h非通气组IL-8水平明显高于持续通气组。MMP-9两组之间无明显差异;持续通气组血浆IL-10的水平在主动脉开放后1 h、4 h和6 h显著高于非通气组。TIMP-1的血浆水平在术后持续升高，在术后1 h和4 h持续通气组较非通气组明显增高。血浆中TXB2水平在主动脉开放后1 h、4 h和6 h明显高于术前水平，持续通气组较非通气组水平明显降低。支气管肺泡灌洗液中IL-8、IL-10、MMP-9和TXB2 水平在主动脉开放后4 h较术前明显升高。TIMP-1水平在主动脉开放后4 h同样显著升高，且持续通气组水平显著高于非通气组，而TXB2水平明显低于非通气组。结论 CPB下CABG中持续通气可明显降低全身炎症反应，对术后肺功能可起到保护作用。 【关键词】 体外循环;全身炎症反应;炎性因子;支气管肺泡灌洗 Impact of Continued Ventilation during Cardioulmonary Bypass onSerum and Bronchoalveolar Lavage Cytokine Response 　　Abstract: OBJECTIVE This study was designed to evaluate the effect of continuing ventilation during cardioulmonary bypass(CPB) on inflammatory reactions. METHODS Sixty patients undergoing coronary artery bypass graft using CPB were randomized to continuous ventilation and nonventilation groups. Plasma interleukin-8, interleukin-10, matrix metalloproteinase-1, tissue inhibitor metalloproteinase-1, and thromboxane B2 level were measured preoperatively, at 1 h, and 4 h,6 h after aortic clamping off. Levels of these mediators were also determined in brochoalveolar lavage preoperatively and four hours after clamping off. RESULTS Plasma levels of IL-8, IL-10, MMP-9 were higher at 1 h, 4 h and 6 h aortic dclamping off in continuous ventilation and the nonventilation group, and IL-8 level were significantly higher in nonventilation group compared with ventilation group, IL-10 levels were significantly higher in the ventilation group than nonventilation group after 1 h and 4 h, 6 h, TIMP-1 levels were significantly higher in the ventilation group than that in nonventilation group after 1 h and 4 h. Bronchoalveolar lavage levels of TIMP-1 were also higher in the continuous ventilation g