CAJ | 학술논문

目的探讨急性主动脉夹层(AAD)围手术期急性肺损伤(ALI)的发生与组织因子(TF)和组织因子途径抑制物(TFPI)的相关性.方法 2012年10月至2013年12月,53例符合条件的ADD患者入组,排除标准为合并心肺疾病和其他肝、肾、神经和血液系统等慢性疾病,其中男43例,女10例,年龄23～ 66岁,平均(45.7±10.3)岁.全身麻醉、深低温停循环(DHCA)和选择性脑灌注下行主动脉弓替换及象鼻支架置入术(孙氏手术).根据术前是否发生ALI分为ALI组(ALI组,22例)和非ALI组(非ALI组,31例).记录患者年龄、性别、体质量指数(BMI)、发病时间、并发症、出入量、ICU呼吸机治疗时间等资料.选取术前12h时(T1)、麻醉诱导后(T2)、术毕(T3)和术后12 h(T4)4个时间点测定氧合指数、TF和TFPI.正态分布计量资料以(x)±s表示,组间比较采用独立因素t检验.非正态分布计量资料以中位数表示,组间比较采用秩和检验.计数资料采用x2检验.相关性分析采用多元线性回归.结果各时间点ALI组氧合指数均低于非ALI组,P＜0.05;各时间点ALI组循环TF和TFPI值均高于非ALI组,P＜0.05;T2和T3时间点ALI组肺泡灌洗液TF和TFPI值均高于非ALI组,P＜0.05;手术失血量和ICU带管时间比较:ALI组均高于非ALI组,P＜0.05.组内比较:两组中T3和T4相比T1,氧合指数下降而循环TF和TFPI值均上升,P＜0.05.T3和T2相比,肺泡灌洗液TF和TFPI值无显著变化,P ＞0.05.多元线性回归分析循环TF与氧合指数呈负相关性(r=-0.622,P＜0.001),肺泡灌洗液TF与氧合指数呈负相关性(r=-0.571,P＜0.001).结论 AAD患者术前即可发生ALI,且围手术期ALI程度逐渐加重.术前发生ALI的患者,围手术期ALI程度以及循环和肺泡灌洗液TF和TFPI均显著增加,且循环和肺泡灌洗液TF与氧合指数呈负相关性.
목적 탐토급성주동맥협층(AAD)위수술기급성폐손상(ALI)적발생여조직인자(TF)화조직인자도경억제물(TFPI)적상관성.방법 2012년10월지2013년12월,53례부합조건적ADD환자입조,배제표준위합병심폐질병화기타간、신、신경화혈액계통등만성질병,기중남43례,녀10례,년령23～ 66세,평균(45.7±10.3)세.전신마취、심저온정순배(DHCA)화선택성뇌관주하행주동맥궁체환급상비지가치입술(손씨수술).근거술전시부발생ALI분위ALI조(ALI조,22례)화비ALI조(비ALI조,31례).기록환자년령、성별、체질량지수(BMI)、발병시간、병발증、출입량、ICU호흡궤치료시간등자료.선취술전12h시(T1)、마취유도후(T2)、술필(T3)화술후12 h(T4)4개시간점측정양합지수、TF화TFPI.정태분포계량자료이(x)±s표시,조간비교채용독립인소t검험.비정태분포계량자료이중위수표시,조간비교채용질화검험.계수자료채용x2검험.상관성분석채용다원선성회귀.결과 각시간점ALI조양합지수균저우비ALI조,P＜0.05;각시간점ALI조순배TF화TFPI치균고우비ALI조,P＜0.05;T2화T3시간점ALI조폐포관세액TF화TFPI치균고우비ALI조,P＜0.05;수술실혈량화ICU대관시간비교:ALI조균고우비ALI조,P＜0.05.조내비교:량조중T3화T4상비T1,양합지수하강이순배TF화TFPI치균상승,P＜0.05.T3화T2상비,폐포관세액TF화TFPI치무현저변화,P ＞0.05.다원선성회귀분석순배TF여양합지수정부상관성(r=-0.622,P＜0.001),폐포관세액TF여양합지수정부상관성(r=-0.571,P＜0.001).결론 AAD환자술전즉가발생ALI,차위수술기ALI정도축점가중.술전발생ALI적환자,위수술기ALI정도이급순배화폐포관세액TF화TFPI균현저증가,차순배화폐포관세액TF여양합지수정부상관성.
Objective To analyze the correlation of the acute lung injury(ALI) and tissue factor(TF)and tissue factor pathway inhibitor(TFPI) of acute aortic dissection(AAD) in perioperative period.Methods Between October 2012 and December 2013,53 AAD patients had admitted undergone open repairs with general anaesthesia and DHCA.Grouped the cases according to the situation of preoperative ALI:group A(22 cases):ALI occurred in preoperative period,group C(31 cases):ALI did not occur in preoperative period.Demographic data were collected.Multiple perioperative factors including age,gender,BMI,AAD onset time,complications,intake and output,mechanic ventilation time in ICU.PaO2/FiO2 and Levels of TF and TFPI were measured at the 12 h before operation (T1),after anesthesia induction (T2),before the end of the operation (T3),and 12 h after operation(T4) respectively.Statistical analysis was processed by SPSS 17.0 software.Measurement data to normal distribution with.(x) ± s,groups were compared with t test.Skewed normal distribution measurement data to the median between the two groups were compared using Wilcoxon test.Count data do chisquare test.Correlation analysis with multiple linear regression.Results Compare PaO2/FiO2:group A was significantly lower than group C at all time points (P ＜0.05),and PaO2/FiO2 had a gradually decreasing trend throughout the procedure in two groups (P ＜ 0.05).Compare TF and TFPI:group A was significantly higher than group C at all time points in blood and at T2 and T3 in BALF (P ＜ 0.05),and TF and TFPI in blood had a gradually increasing trend throughout the procedure in two groups (P ＜ 0.05).Compare blood loss and mechanic ventilation time in ICU:group A was significantly higher than group C (P ＜ 0.05).TF in blood and PaO2/FiO2 present a negative correlation(r =-0.622,P ＜ 0.001).TF in BALF and PaO2/FiO2 present a negative correlation (r =-0.571,P ＜0.001).Conclusion The AAD patients can be attacked with preoperative ALI.The severity of ALI had a gradually increasing trend throughout the procedure.TF and TFPI had a higher level in AAD patients with preoperative ALI.TFand PaO2/FiO2 present a negative correlation.