肺开放策略对体外循环白细胞介素的影响

目的研究肺开放策略(OLC)对体外循环(CPB)手术后白细胞介素的影响。方法选择24例心内直视手术患者,随机分成常规机械通气组(CMV)、早期肺开放组(EOL)、晚期肺开放组(LOL)。EOL组在气管插管后实施OLC,LOL组到达ICU后30min实施OLC;分别于术前、CPB后及到ICU后3、5、24、48h以酶联免疫吸附反应(ELISA)技术测定白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)水平。结果各组CPB后IL-8、IL-10、IL-6均较术前显著升高(P<0.01或P<0.05),组间比较差异无显著性(P>0.05)。IL-8水平在两肺开放组呈显著下降趋势,EOL组在到ICU后24h恢复术前水平,LOL组在到ICU后48h后恢复术前水平,但CMV组各时点均显著高于术前(P<0.01或P<0.05)。IL-10水平只在EOL组呈显著下降趋势,EOL组在到ICU后5h即恢复术前水平,而LOL组及CMV组在到ICU后24h仍显著高于术前(P<0.01或P<0.05)。未见OLC对IL-6的显著影响,各时点组间IL-6的差异无显著性(P>0.05)。结论OLC可减轻CPB相关的肺损伤从而减少炎性细胞因子的释放,早期实施OLC优于晚期实施OLC。

Effects of Open Lung Concept on Interleukins Induced by Cardiopulmonary Bypass

Objective To explore the effects of open lung concept(OLC) on interleukins in patients undergoing cardio-pulmonary bypass(CPB).Methods 24 patients undergoing cardiac surgery with CPB were divided randomly into conventional mechanical ventilation group(CMV),early open lung group,EOL and late open lung group,LOL.The serums were obtained preoperatively,at the end of CPB and 3,5,24,48h after arrival at ICU in all groups.The concentrations of interleukin 6(IL-6),interleukin-8(IL-8) and interleukin-10(IL-10) were measured with ELISA.Results Immediately after cessation of CPB,IL-8,IL-10,IL-6 were significantly elevated compared with preoperative values(P<0.01 or P<0.05),but these concentrations were comparable between the groups(P>0.05).The decrease tendency in IL-8 after CPB was significantly greater in both OLC groups compared with the CMV group.In CMV group,IL-8 concentrations remained significantly elevated at all study time points(P<0.01 or P<0.05).In EOL group,it returned to baseline at 24h after arrival at ICU while in LOL group,it was until 48h.The decrease tendency in IL-10 after CPB was only significantly greater in the EOL group and at 5h after arrival at ICU,IL-10 was comparable to preoperative values.In LOL and CMV groups,however,IL-10 concentrations remained significantly elevated until 24h after arrival at ICU.IL-6 concentrations were comparable between all groups(P>0.05).Conclusion OLC ventilation leads to an attenuated inflammatory response by reducing additional lung injury after cardiac surgery.Early application of OLC has a more pronounced effect compared with late application of this ventilation strategy.