远隔缺血预处理对心脏瓣膜置换术患者肺功能、血流动力学和炎性因子的影响

目的 探讨远隔缺血预处理对心脏瓣膜置换术患者肺功能、血流动力学和炎性因子的影响.方法 选取笔者医院行择期心脏瓣膜置换术的患者60例为受试对象,随机分为远隔缺血预处理组（观察组）和对照组,每组各30例.观察组的患者在麻醉诱导后给予加压远隔缺血预处理,对照组则仅给予止血带.观察两组患者不同时间点肺功能、血流动力学和炎性因子的变化.结果 与麻醉诱导前（T0）相比,两组患者的肺泡-动脉氧分压差alveolar-arterial oxygen tension gradient,D（A-a）O2]、呼吸指数（respiratory index,RI）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）和8（interleukin-8,IL-8）和中心静脉压（central venous pressure,CVP）的水平均呈现显著升高（P＜0.05）,而和氧合指数（oxygenation index,OI）、心率（heart rate,HR）、平均动脉压（mean arterial pressure,MAP）、心脏指数（cardiac index,CI）和肺毛细血管嵌压（pulmonary capillary wedge pressure,PCWP）均出现不同程度的降低（P＜0.05）;与对照组相比,观察组患者肺功能和血流动力学指标的改善程度显著优于对照组（P＜0.05）,但是两组患者炎性因子的比较则无明显差别（P＞0.05）.结论 远隔缺血预处理可改善心脏瓣膜置换术患者肺功能和血流动力学指标,但对炎性反应的抑制则无明显作用.

Effects of Remote Ischemic Preconditioning on Lung Function,Hemodynamic and Inflammatory Factors in Patients with Heart Valve Replacement Surgery

Objective To investigate the effects of remote ischemic preconditioning on lung function,hemodynamic and inflammatory factors in patients with heart valve replacement surgery.Methods Sixty patients with heart valve replacement surgery in our hospital were selected as subjects,and were divided into remote ischemic preconditioning group （observed group） and the control group according to the random number.Each group had 30 cases.Patients in the observed group were given pressure remote ischemic preconditioning after the induction of anesthesia,whereas the control group only received a tourniquet.Lung function,hemodynamics and inflammatory factors were observed in different time points.Results Compared to induction of anesthesia time point （To）,alveolar-arterial oxygen tension gradient D（A-a） O2],respiratory index （RI） values,tumor necrosis factor-α （TNF-α）,IL-6,IL-8 and CVP showed an increase in both two groups （P ＜ 0.05）,while OI values,HR,MAP and CI were in different degrees of reduction （P ＜ 0.05）.Moreover,compared with the control group,the degree of improvement in lung function and hemodynamic indices of patients in the observed group were significantly better than the control group （P ＜ 0.05）,but there was no significant difference in inflammatory factors （P ＞ 0.05）.Conclusion Remote ischemic preconditioning can improve lung function and heart valve replacement surgery in patients with hemodynamic indexes,but it has no significant effect on the inhibition of the inflammatory response.