CAJ | 학술논문

目的评价七氟醚后处理对心脏瓣膜置换术患者体外循环(CPB)后肺功能的影响.方法择期行CPB下心脏瓣膜置换术患者30例,年龄33 ～ 64岁,体重47 ～ 81kg,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级.采用随机数字表法,将患者分为2组(n=15):对照组(C组)和七氟醚后处理组(S组).S组于主动脉开放前通过CPB机预充2％七氟醚,主动脉开放后继续洗入2％七氟醚15 min.分别于麻醉前(T1)、劈开胸骨后即刻(T2)、停止CPB后30 min(T3)、术后6h(T4)、12h(T5)和24h(T6)时采集桡动脉血样,行血气分析,记录PaO2、SaO2,计算氧合指数(OI)、肺泡动脉氧分压差(DA-aO2)；计算动态肺顺应性(Cdyn)和静态肺顺应性(Cstat).分别于T1、T3、T4、T6时采集桡动脉血样,采用ELISA法测定血清白细胞介素-17A(IL-17A)、中性粒细胞弹性蛋白酶(NE)和基质金属蛋白酶-9(MMP-9)的浓度.记录术后机械通气时间、气管导管拔除后24h内呼吸困难、再次气管插管以及肺部哕音的发生情况.结果与C组比较,S组T4-T6时OI升高,T5、T6时DA-aO2降低,T4、T5时PaO2升高,T3、T6时SaO2升高,T3、T4时Cdyn升高,T4时Cstat升高,T3、T4和T6时血清IL-17A、NE和MMP-9浓度降低,机械通气时间缩短,肺部哕音发生率降低(P＜0.05),呼吸困难发生率差异无统计学意义(P＞0.05),2组均未再次气管插管.结论七氟醚后处理可改善心脏瓣膜置换术患者CPB后肺功能,机制可能与抑制炎性反应有关.
목적 평개칠불미후처리대심장판막치환술환자체외순배(CPB)후폐공능적영향.방법 택기행CPB하심장판막치환술환자30례,년령33 ～ 64세,체중47 ～ 81kg,성별불한,ASA분급Ⅱ혹Ⅲ급,NYHA심공능분급Ⅱ혹Ⅲ급.채용수궤수자표법,장환자분위2조(n=15):대조조(C조)화칠불미후처리조(S조).S조우주동맥개방전통과CPB궤예충2％칠불미,주동맥개방후계속세입2％칠불미15 min.분별우마취전(T1)、벽개흉골후즉각(T2)、정지CPB후30 min(T3)、술후6h(T4)、12h(T5)화24h(T6)시채집뇨동맥혈양,행혈기분석,기록PaO2、SaO2,계산양합지수(OI)、폐포동맥양분압차(DA-aO2)；계산동태폐순응성(Cdyn)화정태폐순응성(Cstat).분별우T1、T3、T4、T6시채집뇨동맥혈양,채용ELISA법측정혈청백세포개소-17A(IL-17A)、중성립세포탄성단백매(NE)화기질금속단백매-9(MMP-9)적농도.기록술후궤계통기시간、기관도관발제후24h내호흡곤난、재차기관삽관이급폐부홰음적발생정황.결과 여C조비교,S조T4-T6시OI승고,T5、T6시DA-aO2강저,T4、T5시PaO2승고,T3、T6시SaO2승고,T3、T4시Cdyn승고,T4시Cstat승고,T3、T4화T6시혈청IL-17A、NE화MMP-9농도강저,궤계통기시간축단,폐부홰음발생솔강저(P＜0.05),호흡곤난발생솔차이무통계학의의(P＞0.05),2조균미재차기관삽관.결론 칠불미후처리가개선심장판막치환술환자CPB후폐공능,궤제가능여억제염성반응유관.
Objective To evaluate the effects of sevoflurane postconditioning on lung function after cardiopulmonary bypass (CPB) in patients undergoing cardiac valve replacement.Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 33-64 yr,weighing 47-81kg,scheduled for cardiac valve replacement with CPB,were equally and randomly divided into control group (group C) or sevoflurane postconditioning group (group S).Anesthesia was induced with iv injection of midazolam,etomidate,fentanyl and rocuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam,fentanyl and pipecuronium.In group S,2％ sevoflurane was washed into the membrane oxygenator at 2 min before aortic unclamping and continuously washed into the membrane oxygenator for 15 min after aortic unclamping.Before anesthesia (T1),immediately after sternum splitting (T2),at 30 min after termination of CPB (T3),and at 6,12 and 24h after operation (T4-6),blood samples were taken from the radial artery for blood gas analysis and PaO2 and SaO2 were recorded.Oxygen index (OI),alveolar-arterial oxygen tension difference (DA-aO2),dynamic pulmonary compliance (Cdyn) and static pulmonary compliance (Cstat) were calculated.Arterial blood samples were collected at T1,T3,T4 and T6 for determination of serum concentrations of IL-17A,neutrophil elastase (NE) and matrix metalloproteinase-9 (MMP-9).The time of mechanical ventilation after surgery and development of dyspnea,re-intubation and pulmonary rales were recorded.Results Compared with group C,OI at T4T6,PaO2 at T4 and T5,SaO2 at T3 and T6,Cdyn at T3 and T4 and Cstat at T4 were significantly increased,DAaO2 at T5 and T6,serum concentrations of IL-17A,NE and MMP-9 at T3,T4 and T6,and the incidence of pulmonary rales were decreased,and the time of mechanical ventilation was shortened (P ＜ 0.05),and no significant change was found in the incidence of dyspnea in group S (P ＞ 0.05).No re-intubation was required in the two groups.Conclusion Sevoflurane postconditioning can improve the lung function after CPB in patients undergoing cardiac valve replacement and inhibition of inflammatory responses may be involved in the mechanism.