中国医药
中國醫藥
중국의약
CHINA MEDICINE
2011年
11期
1318-1320
,共3页
李刚%崔丽芳%李常忠%孙弘
李剛%崔麗芳%李常忠%孫弘
리강%최려방%리상충%손홍
冠状动脉搭桥手术%长托宁%炎性细胞因子%心肺转流
冠狀動脈搭橋手術%長託寧%炎性細胞因子%心肺轉流
관상동맥탑교수술%장탁저%염성세포인자%심폐전류
Coronary artery bypass graft%Penrhyclidine hydrochloride%Inflammatory cell factor%Cardiopulmonary bypass
目的 观察长托宁对冠状动脉脉搭桥术(CABG)心肺转流(CPB)炎性细胞因子的影响.方法 39例接受CABG手术的患者完全随机分为长托宁1组、长托宁2组和对照组,各13例.长托宁1组和长托宁2组术前30 min肌内注射长托宁0.02～0.03 mg/kg；长托宁2组术后第24、48小时各静脉追加一次长托宁0.02～0.03 mg/kg；对照组术前30 min肌内注射阿托品0.01 mg/kg.观察3组患者注药前及注药30 min后体温及心率,分别于麻醉诱导前、CPB开始30 min、术后即刻、术后24、48 h采动脉血检测肿瘤坏死因子a(TNF-ct)、白细胞介素6(IL-6)和IL-8的浓度；观察术后胸部X线片肺炎发生率、呼吸机支持时间及ICU停留时间.结果 注药30 min后对照组患者的心率较注药前明显升高[(78.2±3.4) 次/min比(61.1±3.2)次/min;P＜0.05],且明显高于长托宁1组和长托宁2组同时间心率[分别为(56.7±1.4)、(58.9±5.3)次/min,均P＜0.05]；与麻醉诱导前相比,CPB后对照组炎性细胞因子的浓度均明显升高,CPB结束时达到最高值,术后缓慢下降,术后24、48 h均高于术前[TNF-a(12.2±2.1)ng/L比(19.4±1.7)ng/L、(26.3±2.5) ng/L、(19.1±1.7)ng/L、(16.3±1.3)ng/L,P＜0.05].组间比较,长托宁1组和长托宁2组最高值明显低于对照组(P＜0.05)；长托宁2组术后第24、48小时TNF-a、IL-6、IL-8值明显低于对照组,长托宁1组和长托宁2组术后呼吸机支持时间和ICU停留时间明显少于对照组[(10.6±3.7)h、(9.6±7.7)h,(11.8±7.7)h,(3.5±1.9)h、(3.0±1.8)h比(3.9±1.8)h,均P＜0.05].结论 CABG患者术前及术后应用长托宁能有效抑制炎症细胞因子TNF-a、IL-6、IL-8的释放,减轻CPB后的肺部炎症,缩短机械通气和ICU停留时间,比单纯术前应用长托宁效果更好.
目的 觀察長託寧對冠狀動脈脈搭橋術(CABG)心肺轉流(CPB)炎性細胞因子的影響.方法 39例接受CABG手術的患者完全隨機分為長託寧1組、長託寧2組和對照組,各13例.長託寧1組和長託寧2組術前30 min肌內註射長託寧0.02～0.03 mg/kg；長託寧2組術後第24、48小時各靜脈追加一次長託寧0.02～0.03 mg/kg；對照組術前30 min肌內註射阿託品0.01 mg/kg.觀察3組患者註藥前及註藥30 min後體溫及心率,分彆于痳醉誘導前、CPB開始30 min、術後即刻、術後24、48 h採動脈血檢測腫瘤壞死因子a(TNF-ct)、白細胞介素6(IL-6)和IL-8的濃度；觀察術後胸部X線片肺炎髮生率、呼吸機支持時間及ICU停留時間.結果 註藥30 min後對照組患者的心率較註藥前明顯升高[(78.2±3.4) 次/min比(61.1±3.2)次/min;P＜0.05],且明顯高于長託寧1組和長託寧2組同時間心率[分彆為(56.7±1.4)、(58.9±5.3)次/min,均P＜0.05]；與痳醉誘導前相比,CPB後對照組炎性細胞因子的濃度均明顯升高,CPB結束時達到最高值,術後緩慢下降,術後24、48 h均高于術前[TNF-a(12.2±2.1)ng/L比(19.4±1.7)ng/L、(26.3±2.5) ng/L、(19.1±1.7)ng/L、(16.3±1.3)ng/L,P＜0.05].組間比較,長託寧1組和長託寧2組最高值明顯低于對照組(P＜0.05)；長託寧2組術後第24、48小時TNF-a、IL-6、IL-8值明顯低于對照組,長託寧1組和長託寧2組術後呼吸機支持時間和ICU停留時間明顯少于對照組[(10.6±3.7)h、(9.6±7.7)h,(11.8±7.7)h,(3.5±1.9)h、(3.0±1.8)h比(3.9±1.8)h,均P＜0.05].結論 CABG患者術前及術後應用長託寧能有效抑製炎癥細胞因子TNF-a、IL-6、IL-8的釋放,減輕CPB後的肺部炎癥,縮短機械通氣和ICU停留時間,比單純術前應用長託寧效果更好.
목적 관찰장탁저대관상동맥맥탑교술(CABG)심폐전류(CPB)염성세포인자적영향.방법 39례접수CABG수술적환자완전수궤분위장탁저1조、장탁저2조화대조조,각13례.장탁저1조화장탁저2조술전30 min기내주사장탁저0.02～0.03 mg/kg；장탁저2조술후제24、48소시각정맥추가일차장탁저0.02～0.03 mg/kg；대조조술전30 min기내주사아탁품0.01 mg/kg.관찰3조환자주약전급주약30 min후체온급심솔,분별우마취유도전、CPB개시30 min、술후즉각、술후24、48 h채동맥혈검측종류배사인자a(TNF-ct)、백세포개소6(IL-6)화IL-8적농도；관찰술후흉부X선편폐염발생솔、호흡궤지지시간급ICU정류시간.결과 주약30 min후대조조환자적심솔교주약전명현승고[(78.2±3.4) 차/min비(61.1±3.2)차/min;P＜0.05],차명현고우장탁저1조화장탁저2조동시간심솔[분별위(56.7±1.4)、(58.9±5.3)차/min,균P＜0.05]；여마취유도전상비,CPB후대조조염성세포인자적농도균명현승고,CPB결속시체도최고치,술후완만하강,술후24、48 h균고우술전[TNF-a(12.2±2.1)ng/L비(19.4±1.7)ng/L、(26.3±2.5) ng/L、(19.1±1.7)ng/L、(16.3±1.3)ng/L,P＜0.05].조간비교,장탁저1조화장탁저2조최고치명현저우대조조(P＜0.05)；장탁저2조술후제24、48소시TNF-a、IL-6、IL-8치명현저우대조조,장탁저1조화장탁저2조술후호흡궤지지시간화ICU정류시간명현소우대조조[(10.6±3.7)h、(9.6±7.7)h,(11.8±7.7)h,(3.5±1.9)h、(3.0±1.8)h비(3.9±1.8)h,균P＜0.05].결론 CABG환자술전급술후응용장탁저능유효억제염증세포인자TNF-a、IL-6、IL-8적석방,감경CPB후적폐부염증,축단궤계통기화ICU정류시간,비단순술전응용장탁저효과경호.
Objective To study the changes of inflammatory cell factor during and after cardiopulmonary bypass (CPB) and clinical effect of penehyclidine hydrochloride injection used in coronary artery bypass graft (CABG).Methods Totally 39 patients receiving CABG were divided into penehyclidine hydrochloride injection group 1,penehyclidine hydrochloride injection group 2 and control group.Before the operation,penehyclidine hydrochloride injection group 1 and penehyclidine hydrochloride injection group 2 were given 0.02-0.03mg/kg of intramuscular injection of penehyclidine.Then 24 hours and 48 hours after the operation,penehyclidine hydrochloride injection group 2 was given 0.02-0.03mg/kg of intramuscular injection of penehyclidine hydrochloride injection respectively.Thirty minutes before the operation,control group received 0.01mg/kg of intramuscular injection of atropin.Body temperature and heart rate of the patients of three groups before and 30 minutes after the injection were observed.The artery blood was picked separately before the anaesthesia induction,30 min after CPB,instantly after the operation,24 hours and 48 hours after the operation.The density of tumor necrosis factor Alpha (TNF-α),the Interleukin 6 (IL-6) and Interleukin 8 (IL-8) by using monoclone antibody enzyme-linked immunosorbent assay (ELISA) were observed.Incidence rate of X sternum pneumonia,support time of breathing machine and resident time in ICU after the operation were analyzed.Results Thirty min after the injection,Heart rate of patients of control group increased,which was higher than that of penehyclidine hydrochloride injection group 1 and penehyclidine hydrechloride injection group 2.After CPB,the density of inflammatory cell factor of patients from control groups all went up clearly compared with that before the anaesthesia induction,reaching the highest when CPB was done,going down gradually after the operation.24 and 48 hours after the operation it was remaining higher than that before the operation[TNF-a:(12.2 ±2.1)ng/L vs (19.4±l.7)ng/L,(26.3 ±2.5)ng/L,(19.1 ±1.7)ng/L,(16.3±1.3) ng/L,P ＜ 0.05 ].The highest levels of penehyclidine hydrochloride injection group 1 and penehyclidine hydrochloride injection group 2 were lower than those of control Group significantly.After the operation,the support time of breathing machine and the resident time in ICU of penehyclidine hydrochloride injection group 1 and Penehyclidine hydrochloride injection group 2 were lower than those of control group significantly[( 10.6 ± 3.7) h,(9.6 ±7.7)h vs (11.8 ±7.7)h; (3.5 ±l.9)h,(3.0±1.8)h vs (3.9 ±1.8)h,P＜0.05].Conclusion Penehyclidine hydrochloride injection controls the release of TNF-α,IL-6 and IL-8 of inflammatory cell factor,relieves pneumonia after CPB and shortens the mechanical airing time in CPU.
