體外循環(huán)中山莨菪堿對肺損傷的保護作用

1、體外循環(huán)中山莨菪堿對肺損傷的保護作用周小蓮 呂志平湘雅二醫(yī)院麻醉科 410011摘 要目的: 體外循環(huán)造成的全身性炎性反應(yīng)及肺的缺血再灌注會造成嚴重肺的損傷，CPB術(shù)后患者的肺功能不同程度下降.因此圍術(shù)期的肺保護具有重要的意義。山莨菪堿具有抗炎及防護器官缺血再灌注損害的作用，本課題主要研究山莨菪堿對體外循環(huán)炎癥因子的影響及對肺損傷的保護作用。方法: 24例擇期首次行心臟瓣膜置換術(shù)患者，ASA分級IIIV級、年齡、體重的差異無顯著性。所有患者均無肝腎功能障礙；左室射血分數(shù)大于40%；血常規(guī)基本正常；無慢性支氣管炎、支氣管哮喘、青光眼、前列腺肥大；近期無肺部感染及接受類固醇激素治療等。隨機分為山莨

2、菪堿組(A組)和對照組(C組)，每組12例。A組按0.8mg/kg的山莨菪堿于轉(zhuǎn)流開始加入預(yù)充液中，經(jīng)轉(zhuǎn)機進入體內(nèi)。C組用等量生理鹽水代替山莨菪堿，用法同A組，麻醉方案兩組相同。分別于誘導(dǎo)切皮前(T1)、轉(zhuǎn)流30min(T2)、停CPB1小時(T3)、4小時(T4)、24小時(T5)抽取動脈血，肝素抗凝，測定紅細胞壓積和動脈血氣分析，余血立即以2000r/min高速離心，取上層血漿，置入-20冰箱內(nèi)保存。根據(jù)試劑盒說明采用放射免疫法測定血漿TNF-、IL-6濃度。按公式：RI=P(A-a)DO2/PaO2 =(Pb-PH2O)×FiO2-PaCO2-PaO2/PaO2 計算。Pb為大

3、氣壓(760mmHg)，PH2O為室溫下飽和水蒸氣壓(47mmHg)。結(jié)果:兩組患者年齡、性別、體重、轉(zhuǎn)流時間、主動脈阻斷時間差異無統(tǒng)計學意義(P>0.05)。兩組間血漿IL-6、TNF-水平和RI值在體外循環(huán)前T1時差異無統(tǒng)計學意義(P>0.05)。C組T2-5各時點TNF-、IL-6均高于T1(P<0.05)，A組T2-5各時點TNF-、IL-6濃度明顯低于C組同時點值(P<0.05)，T3、T4各時點C組的RI較T1和A組同時點顯著增高(P<0.05)。RI與IL-6、TNF-P<0.01)。結(jié)論:山莨菪堿能有效地抑制體外循環(huán)心臟直視手術(shù)圍術(shù)期促炎細胞

4、因子的釋放, 因而能減輕體外循環(huán)引起的急性炎癥反應(yīng),從而改善肺功能。關(guān)鍵詞: 山莨菪堿 體外循環(huán) 肺保護 IL-6 TNF-The protective effect of anisodamine on lung injury during cardiopulmonary bypassABSTRACTObjective: The purpose of this study was to investigate the effect of anisodamine on lung injury during cardiopulmonary bypass. Methods: Twenty four

5、patients scheduled for elective valve replacement under cardiopulmonary bypass, which had no significant difference existed between two groups in ASA grade, age and body height,no signs of liver function failure and renal failure ; left ventricle ejection fraction exceed 40%; blood routine examinati

6、on is normal probably; no history of chronic bronchitis、bronchial asthma、glaucoma and prostatauxe;no pulmonary infection or receiving hormone in these days , were randomly divided into two groups of 12 patients each. In the experimental group, the patients received anisodamine 0.8mg/kg by adding int

7、o the primary solution at the beginning of by-pass,with control group received normal saline instead of anisodamine. Blood samples were taken from radial artery for determination of IL-6 and TNF- concentrations and blood gas analysis before operation(T1),30min after initiation of cpb(T2),1 h(T3),4h(

8、T4)and 24h(T5)after cpb. Respiratory index was calculated at T1, T3, T4.Results: The age、sex ratio 、body weight、time of cpb and time of blocking aorta had no significant difference in both groups(P>0.05). the plasma levels of TNF-、IL-6 and respiratory index had no significant difference in both g

9、roups at T1(P>0.05). in control group the plasma levels of TNF-、IL-6 were significantly higher than the baseline values during and after cpb(P<0.05).TNF-、IL-6 concentrations and respiratory index were significantly higher in control group than in experimental group after cpb(P<0.05).Respiratory index was positively correlated with plasma concentration of TNF- and IL-6.The “r” were 0.70 and 0.67(P<0.01).Conclusion: This results show that anisodamine can effectively suppress the production of the cytokine during