CAJ | 학술논문

目的：评价盐酸戊乙奎醚复合谷胱甘肽对体外循环(cardiopulmonary bypass，CPB)心脏瓣膜置换术患者肺损伤的影响。方法：择期行CPB下心脏瓣膜置换术患者80例，年龄35~66岁，体质量51~78 kg，性别不限，ASAⅡ或Ⅲ级，采用随机数字表法分为4组(n=20)：对照组(C组)、盐酸戊乙奎醚组(P组)、谷胱甘肽组(G组)和盐酸戊乙奎醚复合谷胱甘肽组(PG组)。麻醉诱导后气管插管，机械通气，采用静吸复合麻醉。于气管插管后P组、G组和PG组分别经颈内静脉注射盐酸戊乙奎醚0.05 mg/kg、谷胱甘肽100 mg/kg、盐酸戊乙奎醚0.05 mg/kg和谷胱甘肽100 mg/kg。与麻醉诱导后30 min(T1)、CPB即刻(T2)、CPB结束后30 min(T3)、3 h(T4)、6 h(T5)和12 h(T6)时，测定血清肿瘤坏死因子α(tumor necrosis factor-alpha，TNF-α)、白细胞介素(interleukin，IL)6和IL-8的质量浓度。与上述各时点取桡动脉血样进行血气分析，计算氧合指数(oxygenation inedx，OI)、呼吸指数(respiratory index，RI)和记录动态肺顺应性(dynamic lung compliance，Cdyn)。结果：与C组比较，P组、G组和PG组血清TNF-α、IL-6和IL-8的质量浓度降低(P<0.05)；与P组和G组比较，PG组TNF-α、IL-6和IL-8的质量浓度降低(P<0.05)；与C组比较，P组、G组和PG组OI、Cdyn升高，RI降低(P<0.05)；与P组和G组比较，PG组OI、Cdyn升高，RI降低(P<0.05)。结论：盐酸戊乙奎醚复合谷胱甘肽可减轻CPB心脏瓣膜置换术患者肺损伤，其机制与减轻肺组织炎症反应及脂质过氧化反应有关。
목적：평개염산무을규미복합곡광감태대체외순배(cardiopulmonary bypass，CPB)심장판막치환술환자폐손상적영향。방법：택기행CPB하심장판막치환술환자80례，년령35~66세，체질량51~78 kg，성별불한，ASAⅡ혹Ⅲ급，채용수궤수자표법분위4조(n=20)：대조조(C조)、염산무을규미조(P조)、곡광감태조(G조)화염산무을규미복합곡광감태조(PG조)。마취유도후기관삽관，궤계통기，채용정흡복합마취。우기관삽관후P조、G조화PG조분별경경내정맥주사염산무을규미0.05 mg/kg、곡광감태100 mg/kg、염산무을규미0.05 mg/kg화곡광감태100 mg/kg。여마취유도후30 min(T1)、CPB즉각(T2)、CPB결속후30 min(T3)、3 h(T4)、6 h(T5)화12 h(T6)시，측정혈청종류배사인자α(tumor necrosis factor-alpha，TNF-α)、백세포개소(interleukin，IL)6화IL-8적질량농도。여상술각시점취뇨동맥혈양진행혈기분석，계산양합지수(oxygenation inedx，OI)、호흡지수(respiratory index，RI)화기록동태폐순응성(dynamic lung compliance，Cdyn)。결과：여C조비교，P조、G조화PG조혈청TNF-α、IL-6화IL-8적질량농도강저(P<0.05)；여P조화G조비교，PG조TNF-α、IL-6화IL-8적질량농도강저(P<0.05)；여C조비교，P조、G조화PG조OI、Cdyn승고，RI강저(P<0.05)；여P조화G조비교，PG조OI、Cdyn승고，RI강저(P<0.05)。결론：염산무을규미복합곡광감태가감경CPB심장판막치환술환자폐손상，기궤제여감경폐조직염증반응급지질과양화반응유관。
Objective:To investigate the effects of penephyclidine hydrochloride combined with glutathione on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass. Methods: 80 ASA physical status Ⅱor Ⅲpatients of both sexes , aged 35-66 , weighing 51-78 kg , undergoing cardiac valve replacement with cardiopulmonary bypass, were randomly divided into 4 groups(n=20 each): control group(group C), penephyclidine hydrochloride group(group P), glutathione group(group G) and penephyclidine hydrochloride+ glutathione group(group PG). Anestheaia was induced with iv injection of midazolam, etomidate, fentanil and Vecuronim. The patients were endotracheally intubated and mechanically ventilated. Group P, G and PG received in injection of penephyclidine hydrochloride 0.05 mg/kg, glutathione 100 mg/kg and penephyclidine hydrochloride 0.05 mg/kg+glutathione 100 mg/kg after tracheal intubation, while group C received equal volume of normal saline. After anerthesia induction 30 min and at 0, 30 min, 3 h, 6 h and 12 h after termination of CPB, blood samples were obtained from right internal jugular vein for determination of levels of serum tumor necrosis factor-alpha (TNF-α), interleukin-6(IL-6) and interleukin-8(IL-8). Blood samples were collected from the left radial artery after anerthesia induction 30 min and at 0, 30 min, 3 h, 6 h and 12 h after termination of CPB for blood gas analysis. The oxygenation index (OI), respiratory index(RI) and dynamic lung compliance(Cdyn) were calculated. Results: Compared with group C, serum concentrations of TNF-α, IL-6 and IL-8 were significantly decreased in group P,G and PG(P<0.05), serum concentrations of TNF-α, IL-6 and IL-8 were significantly lower in group PG than those in group P and G(P<0.05). OI and Cdyn were significantly increased and RI was significantly decreased in group P , G and PG compared with group C ( P<0 . 05 ) , and in group PG compared with group P and G(P<0.05). Conclusion:Penephyclidine hydrochloride combined with glutathione can attenuate lung injury by inhibition inflammatory response in patients undergoing cardiac valve replacement with CPB.