急性主动脉夹层围术期肺损伤与纤溶酶原激活物抑制剂的相关性探讨

目的:探讨急性主动脉夹层(AAD)围术期急性肺损伤(ALI)的发生与循环和肺泡灌洗液纤溶酶原激活物抑制剂(PAI-1)的相关性。方法:2012年10月至2013年12月期间,符合入组条件的ADD患者共53例,在全身麻醉、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分为两组:术前ALI组(A组,n=22)组和术前非ALI组(C组,n=31)。收集患者年龄、性别、体质量指数(BMI)、发病时间、合并症、出入量、ICU呼吸机治疗时间等资料。选取术前12h(T1)、麻醉诱导后(T2)、术毕(T3)和术后12h(T4)四个时间点测定氧合指数和PAI-1。对各组结果进行比较,各因素与氧合指数的相关性采用多元线性回归分析。结果:组间比较,各时间点A组氧合指数均低于C组,P0.05。各时间点A组循环PAI-1值均高于C组,P0.05。T2和T3时间点A组肺泡灌洗液PAI-1值均高于C组,P0.05。手术失血量和ICU带管时间比较:A组均显著高于C组,P0.05。组内比较,两组中T3和T4相比T1,氧合指数减少而循环PAI-1值增加,P0.05。两组T3与T2相比,肺泡灌洗液PAI-1值增加,P0.05。多元线性回归分析循环PAI-1值与氧合指数呈负相关性(r=-0.504,P0.001),肺泡灌洗液PAI-1与氧合指数呈负相关性(r=-0.606,P0.001)。结论:AAD患者术前即可发生ALI,且围术期ALI程度逐渐加重。术前发生ALI的患者,围术期ALI程度以及循环和肺泡灌洗液PAI-1水平均显著升高,并与氧合指数呈负相关性。

Correlative study of perioperative acute lung injury and plasminogen activator inhibitor-1 of acute aortic dissection

Objective：To analyze the correlation of the acute lung injury （ALI） and plasminogen activator inhibitor-1 （PAI-1） 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 PAI-1 were measured at the 12h 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 SPSS13.0 software.Groups were compared with t 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 PAI-1：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 PAI-1 in blood and BALF 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）.PAI-1 in blood and PaO2/FiO2 present a negative correlation（r =-0.504,P ＜0.001）.PAI-1 in BALF and PaO2/FiO2 present a negative correlation （r =-0.606,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.PAI-1 had a higher level in AAD patients with preoperative ALI.PAI-1 and PaO2/FiO2 present a negative correlation.