CAJ | 학술논문

目的评价远隔肢体缺血预处理对腹主动脉瘤手术病人肺损伤的影响.方法择期行肾下型腹主动脉瘤切除人工血管置换术病人62例,性别不限,年龄54～72岁,体重指数21 ～ 36kg/m2,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将病人随机分为2组(n=31):对照组(C组)和远隔肢体缺血预处理组(RLIP组).RLIP组在麻醉诱导后手术前将左上肢用袖带加压至200 mm Hg 5 min后袖带放气5 min,重复2次.分别于气管插管后10 min(T0)、主动脉开放后30 min(T1)、术后4 b(T2)、8h(T3)、12 h(T4)、24 h(T5)时采集动脉和静脉的血样,进行动脉血气分析,计算肺泡-动脉血氧分压差(PA-aaO2)和呼吸指数(RI),并测定静脉血血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度、血浆超氧化物歧化酶(SOD)活性和丙二醛(MDA)浓度.分别于上述时点记录气道峰压(Ppeak)、气道平台压(Pplat)和呼气末正压(PEEP),以计算肺动态顺应性(Cs)和肺静态顺应性(Cd).记录术后低氧血症发生情况、拔除气管导管时间和ICU停留时间.结果与C组比较,RLIP组PA-aO2、RI和血IL-6、TNF-α和MDA的浓度降低,Cs、Cd和血SOD活性升高,术后低氧血症发生率降低,ICU停留时间和拔除气管导管时间缩短(P＜0.05).结论远隔肢体缺血预处理可减轻腹主动脉瘤手术病人肺损伤,其机制与抑制炎性反应及脂质过氧化反应有关.
목적 평개원격지체결혈예처리대복주동맥류수술병인폐손상적영향.방법 택기행신하형복주동맥류절제인공혈관치환술병인62례,성별불한,년령54～72세,체중지수21 ～ 36kg/m2,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장병인수궤분위2조(n=31):대조조(C조)화원격지체결혈예처리조(RLIP조).RLIP조재마취유도후수술전장좌상지용수대가압지200 mm Hg 5 min후수대방기5 min,중복2차.분별우기관삽관후10 min(T0)、주동맥개방후30 min(T1)、술후4 b(T2)、8h(T3)、12 h(T4)、24 h(T5)시채집동맥화정맥적혈양,진행동맥혈기분석,계산폐포-동맥혈양분압차(PA-aaO2)화호흡지수(RI),병측정정맥혈혈청백세포개소-6(IL-6)、종류배사인자-α(TNF-α)농도、혈장초양화물기화매(SOD)활성화병이철(MDA)농도.분별우상술시점기록기도봉압(Ppeak)、기도평태압(Pplat)화호기말정압(PEEP),이계산폐동태순응성(Cs)화폐정태순응성(Cd).기록술후저양혈증발생정황、발제기관도관시간화ICU정류시간.결과 여C조비교,RLIP조PA-aO2、RI화혈IL-6、TNF-α화MDA적농도강저,Cs、Cd화혈SOD활성승고,술후저양혈증발생솔강저,ICU정류시간화발제기관도관시간축단(P＜0.05).결론 원격지체결혈예처리가감경복주동맥류수술병인폐손상,기궤제여억제염성반응급지질과양화반응유관.
Objective To investigate the effects of remote limb ischemic preconditioning (RLIP) on the lung injury in patients undergoing abdominal aortic aneurysm repair.Methods Sixty-two ASA Ⅱ or Ⅲ patients of both sexes,aged 54-72 yr,with body mass index 21-36 kg/m2,undergoing elective abdominal aortic aneurysm repair,were randomly divided to 2 groups ( n =31 each):control group (group C) and RLIP group.RLIP consisted of two 5-min cycles of left upper limb ischemia induced by a blood pressure cuff placed on the left upper arm and inflated to 200 mm Hg,with an intervening 5 min of reperfusion,during which time the cuff was deflated.RLIP was performed after anesthesia induction and before the start of surgery.Arterial and venous blood samples were taken at 10 min after intubation (T0),and 30 min and 4,8,12 and 24 h after aortic unclamping (T1-5) for blood gas analysis and determination of the concentrations of serum interleukin (IL)-6,tumor necrosis factor (TNF)-α,and plasma malondialdehyde (MDA) and superoxide dismutase (SOD) activity.The alveolar-arterial oxygen pressure difference (PA-aO2 ) and respiratory index (RI) were calculated.The peak airway pressure (Ppeak),plat airway pressure (Pplat) and positive end expiratory pressure (PEEP) were recorded at the same time points mentioned above to calculate dynamic lung compliance (Cd) and static lung compliance (Cs).The incidence of hypoxemia,extubation time and duration of stay in intensive care unit (IGU) were also recorded.Results Compared with group C,PA-aO2,RI and the concentration of IL-6 were significantly decreased at T3-5,Cs,Cd and SOD activity were significantly increased at T2-5,and the concentrations of TNF-α and MDA were significantly decreased at T2-5 in group RLIP ( P ＜ 0.05).Compared with group C,the incidence of hypoxemia was significantly decreased,and extubation time and duration of stay in ICU were significantly shortened in group RLIP ( P ＜ 0.05).Conclusion RLIP can reduce the lung injury through inhibition of the inflammatory response and lipid peroxidation in patients undergoing abdominal aortic aneurysm repair.