还原型谷胱甘肽预处理对体外循环肺缺血再灌注损伤的保护作用

目的：观察还原型谷胱甘肽预处理对体外循环缺血再灌注损伤的保护作用。方法：16例人工瓣膜置换患者随机分成对照组及预处理组。预处理组在术前36h静脉给予生理盐水稀释的GSH；对照组则给予生理盐水，测定CPB前、复跳后5，10，15min时，左、右心腔血中丙二醛(MDA)，凝血VⅢ因子(FVⅢ)及游离血红蛋白(FHb)浓度并计算其差值。取CPB前、复跳后10min，1h及6h时桡动脉血测定氧合指数。结果：两组氧合指数术后均降低，但预处理组明显低于对照组。左心腔血浆中MDA，FVⅢ及FHb浓度均高于右心腔。预处理组中各指标增高值均低于对照组，差异均有显著性。两组中，MDA增高值与FVⅢ增高值，FHb增高值与MDA增高值及FHb增高值与FVⅢ增高值之间均呈直线相关(r分别为0.774，0．753及0．802)。结论：还原型谷胱甘肽预处理可减轻CPB时肺缺血再灌注早期损伤。其机制可能是通过减少FHb生成，降低自由基反应而实现的。

Effect of glutathione pretreatment on lung ischemia-reperfusion injury during cardiopulmonary bypass]

OBJECTIVE: To observe the clinical effect of glutathione (GSH) pretreatment on lung ischemia-reperfusion injury during cardiopulmonary bypass (CPB) and determine the mechanism. METHODS: Sixteen patients ready to replace heart valve(s) were randomly divided into the control and the treatment group. GSH diluted with normal saline solution was injected to the patients in the treatment group 36 h before the operation, while normal saline solution was injected to the patients in the control group. Malondiadehyde (MDA), Factor V III (FV III) and free hemoglobin (FHb) were detected in the left and right heart chamber at pre-CPB 5, 10, and 15 minutes after the heart resuscitation. The differences between the left and right were recorded. Arterial blood from the radius was analyzed for PO2/FiO2 at pre-CPB, 10 min, 1 h and 6 h after the heart resuscitation. RESULTS: (1) The impairment of PO2/FiO2 in the treatment group was less than that in the controls. (2) MDA, FV III and FHb concentration in the left chamber were higher than those in the right. Increases of the parameters in the treatment group were lower than those in the controls. (3) The simple correlations were determined between MDA-FV III, FHb-MDA and FHb-FV III in both the control and the treatment groups (r = 0.774, 0.753 and 0.802), with statistical significance. CONCLUSION: GSH pretreatment can protect early lung ischemia-reperfusion injury during CPS, whose mechanism may be to decrease the leakage of FHb, and inhibit the free radicals reaction.