CAJ | 학술논문

目的探讨氟比洛芬酯(FA)对心脏瓣膜置换术患者白介素-10(IL-10)及肺表面活性物质相关蛋白A(SP-A)的影响。方法选择风心病瓣膜置换术患者40例,随机均分为2组：实验组在麻醉诱导前静脉注射FA 1 mg/kg；对照组在麻醉诱导前静脉注射等剂量的生理盐水(0.1 ml/kg)。分别于麻醉诱导前(T0)、主动脉阻断前5 min(T1)、主动脉开放后5 min(T2)、体外循环(CPB)结束后30 min(T3)、2 h (T4)、24 h(T5)抽取动脉血5 ml,测动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、血氧饱和度(SaO2),计算肺泡动脉氧分压差(A-aDO2)、氧合指数(OI)、呼吸指数(RI),同时检测血清SP-A及IL-10水平。结果两组患者性别、年龄、体重、术前左室射血分数(EF值)、心功能分级、转流时间、主动脉阻断时间、手术时间、术中最低温度的变化差异均无统计学意义,实验组机械通气时间低于对照组(P<0.05),实验组A-aDO2、RI在T4明显低于对照组(P<0.05),实验组OI在T3、T4明显高于对照组(P<0.01),CPB开始后,两组患者血清SP-A、IL-10均进行性升高,在T2达高峰,后逐渐下降,但均高于同组 T0水平( P <0.05)。实验组 SP-A 在T2、T3、T4明显低于对照组( P <0.05),而实验组 IL-10在T2、T3、T4则明显高于对照组(P<0.05)。结论FA可以缩短机械通气时间,改善CPB后肺换气及氧合功能,并可降低血清SP-A水平、提高血清IL-10水平,提示其在抑制全身炎性反应的同时,可能降低了CPB后肺毛细血管通透性,平衡细胞因子和抑制过度应激反应,对保护肺功能有一定的作用。
목적탐토불비락분지(FA)대심장판막치환술환자백개소-10(IL-10)급폐표면활성물질상관단백A(SP-A)적영향。방법선택풍심병판막치환술환자40례,수궤균분위2조：실험조재마취유도전정맥주사FA 1 mg/kg；대조조재마취유도전정맥주사등제량적생리염수(0.1 ml/kg)。분별우마취유도전(T0)、주동맥조단전5 min(T1)、주동맥개방후5 min(T2)、체외순배(CPB)결속후30 min(T3)、2 h (T4)、24 h(T5)추취동맥혈5 ml,측동맥양분압(PaO2)、동맥이양화탄분압(PaCO2)、혈양포화도(SaO2),계산폐포동맥양분압차(A-aDO2)、양합지수(OI)、호흡지수(RI),동시검측혈청SP-A급IL-10수평。결과량조환자성별、년령、체중、술전좌실사혈분수(EF치)、심공능분급、전류시간、주동맥조단시간、수술시간、술중최저온도적변화차이균무통계학의의,실험조궤계통기시간저우대조조(P<0.05),실험조A-aDO2、RI재T4명현저우대조조(P<0.05),실험조OI재T3、T4명현고우대조조(P<0.01),CPB개시후,량조환자혈청SP-A、IL-10균진행성승고,재T2체고봉,후축점하강,단균고우동조 T0수평( P <0.05)。실험조 SP-A 재T2、T3、T4명현저우대조조( P <0.05),이실험조 IL-10재T2、T3、T4칙명현고우대조조(P<0.05)。결론FA가이축단궤계통기시간,개선CPB후폐환기급양합공능,병가강저혈청SP-A수평、제고혈청IL-10수평,제시기재억제전신염성반응적동시,가능강저료CPB후폐모세혈관통투성,평형세포인자화억제과도응격반응,대보호폐공능유일정적작용。
Objective To investigate the effects of flurbiprofen ( FA) on interleukin-10( IL-10) and pulmonary surfactant-associated protein A(SP-A) in cardiac valve replacement patients. Methods Forty patients undergoing cardiac valve replacements were divided into control group and observation group randomly with 20 each. Patients in observation group were given FA 1 mg/kg before induction of anesthesia; patients in control group were given the same-volume saline instead. The arterial blood samples of 5 ml each were taken for measured arterial oxygen (PaO2 ), arterial carbon dioxide partial pressure (PaCO2 ), oxygen saturation (SaO2 ),then calculated the alveolar-arterial oxygen difference (A-aDO2 ), oxygen composite index (OI) and respiratory index (RI) before induction of anesthesia (T0), at 5 min before aortic cross clamp (T1), at 5 min after aortic open (T2), at 30 min (T3), 2 h (T4)and 24 h (T5)after cardiopulmonary bypass (CPB), while serum concentrations of SP-A and IL-10 were ana-lyzed and compared. Results Compared with control group,the time of duration of mechanical ventilation in obser-vation group was shorter (P<0.05). Compared with control group,A-aDO2 and RI in observation group were de-creased at T4 (P<0.05), OI in observation group at T3 and T4 was increased significantly (P<0.01). As CPB started, serum concentrations of SP-A and IL-10 in two groups were progressively increased, and peaked at T2, then gradually decreased. Compared with T0, serum concentrations of SP-A and IL-10 were increased obviously from T1 to T5 in both groups(P<0.05). Compared with control group,serum concentration of SP-A in observation group was decreased from T2 to T4 (P<0.05), while serum concentration of IL-10 in observation group was in-creased from T2 to T4 (P<0.05). Conclusion FA can shorten the time of duration of mechanical ventilation, improve pulmonary ventilation and oxygenation after CPB. It can also decrease serum concentration of SP-A, in-crease serum concentration of IL-10. FA can decrease inflammatory response, reduce post-CPB pulmonary capillary permeability, balance the cytokines and curb excessive stress response,which may be play a protective role for the lung injury.