白细胞过滤对肺保护作用临床探究.docVIP

白细胞过滤对肺保护作用临床探究 　 作者：章晓华，张希，肖学钧，吴若彬，郑少忆，熊卫萍，王文贤，陈萍，罗智超 【摘要】 目的 探讨心肺再灌注早期循环血白细胞过滤对体外循环(Extracorporeal circulation，ECC)心瓣膜置换术患者的肺保护作用。方法 52例心瓣膜置换术患者，随机分成实验组(EG)和对照组(CG)。实验组在动脉旁路上并行安装白细胞滤器（Pall LG-6），白细胞滤器开放时间在心肺再灌注前5 min～10 min至ECC结束；对照组仅用ECC常规动脉滤器。观察术中及术后循环血白细胞计数、再灌注肺内白细胞隔离、ECC前后肺动脉压改变、机械辅助通气和动脉血气分析。 结果 ① 在心肺再灌注前，白细胞过滤可显著降低循环血中的白细胞计数；②再灌注15 min时白细胞过滤对肺内白细胞隔离的影响并不明显；③白细胞过滤可缓和ECC后肺动脉压力的上升；④白细胞过滤可显著降低术后呼吸指数(RI)和提高机械通气氧合指数(OI)。 结论 再灌注前及再灌注早期循环血白细胞过滤可明显改善心瓣膜置换术患者术后肺功能。 【关键词】 白细胞过滤器；肺保护；体外循环；心脏瓣膜置换术 　　Abstract: OBJECTIVE To evaluate the effects of leukocyte depletion filter during the early period of cardiopulmonary reperfusion on lung protection in patients undergoing valve surgery. METHODS Fifty-two patients underwent elective mitral valve or mitral and aortic valves replacement surgery in this study. All the patients were randomly divided into two groups，experimental group(EG)26 cases and control group (CG) 26 cases.The CG only used the TERUMO ordinary arterial line filter, and the EG used the Pall LG-6 leukocyte depletion filter and TERUMO filter in a parallel way. The leukocyte depletion filter were used from 5 to 10 minutes before aortic cross clamp released to the end of ECC. Intra- and postoperative variables consist of leukocyte counts, pulmonary leukocyte sequestration, pulmonary artery pressure pre- and post-ECC, mechanic assist ventilation and arterial blood gases were measured. Statistical analysis using indepent-samples t-tests, paired-samples t-test, correlate and chi-square (SPSS11.5) was performed on all data to test for significant differences. RESULTS The counts of leukocyte were reduced significantly before cardiopulmonary reperfusion in the patients undergoing leukocyte depletion filtration. No detectable benefit was found to pulmonary leukocyte sequestration for the leukocyte depletion filtration during the period of reperfusion. The elevating of pulmonary artery pressure post-ECC could be relieved, and the postoperative oxygenation ability of lung i