七氟烷对体外循环术后早期肺炎症反应的影响

目的：观察全程七氟烷吸入对体外循环（CPB）下冠脉搭桥患者术后早期肺炎症递质变化的影响.方法：选择择期在CPB下行冠脉搭桥手术患者30例,年龄45- 75岁,术前心功能Ⅱ-Ⅲ级,按单盲法随机分为2组,七氟烷组（S组）和丙泊酚组（P组）,每组15例.2组患者均经静脉依次注入咪唑安定0.05 mg/kg、舒芬太尼1.0 μg/kg、依托咪酯0.3 mg/kg和维库溴铵0.15 mg/kg,并予气管插管.插管后S组全程吸入七氟烷,P组全程靶向控制输注（TCI）丙泊酚维持麻醉,其余用药相同.于打开心包后,CPB前（T0）、心脏复跳后5 min （T1）、15 min （T2）、30 min （T3）、1 h（T4）,留取肺动脉（PA）和肺静脉（Pv）血,以测定人中性粒细胞弹性蛋白酶（HNE）、白介素-6（IL-6）、白介素-10 （IL-10）浓度,并计算PV和PA的浓度比,同时记录主动脉阻断时间、CPB时间、CPB中血管活性药物使用总量、术后气管导管留存时间、冠心病监测治疗室（CCU）住院时间.结果：2组HNE、IL-6、IL-10在PV、PA中浓度之比在T0时点差异无统计学意义（P＞ 0.05）,心脏复跳后2组HNE、IL-6在PV、PA中含量之比均有不同程度的上升,但S组在各时点的上升程度均低于P组（P＜0.01或P＜ 0.05）;IL-10在CPB后PV/PA比值亦明显上升,且S组上升程度明显高于P组,差异均有统计学意义（P＜0.01或P＜ 0.05）;此外,与P组比较,S组在CPB期间血管活性药物使用量少（P＜0.05）,术后气管导管留存时间和CCU住院时间更短（P＜ 0.05）.结论：全程七氟烷吸入能有效减轻CPB下冠脉搭桥术后早期肺炎症反应,缩短气管导管留存时间和患者在CCU治疗的时间,且更有利于CPB期间血流动力学的平稳.

Effects of sevoflurane on pulmonary inflammatory responses after cardiopulmonary bypass in early stage

Objective：To observe the effects of sevoflurane inhalation on changing inflammatory mediators in the early stage after cardioversion in patients receiving coronary artery bypass grafting under cardiopulmonary bypass （CPB）.And to provide a theoretical basis for the selection and application of general anesthesia drug.Methods：Thirty patients,ASA status Ⅱ or Ⅲ,45 to 75-year-old,undergoing coronary artery bypass grafting under CPB for the first time were included and randomized into two groups：sevoflurane group （group S,n=15） and propofol group （group P,n=15）.0.05 mg/kg midazolam,1.0 μg/kg sufentanil,0.3 mg/kg etomidate,and 0.15 mg/kg vecuronium were injected into two groups of patients and then the tracheal intubation were inserted.In group S,the sevoflurane was inhaled during the whole operation.including the CPB procedure.While in group P,propofol was administrated by Target Controlled Infusion system instead,and the other were same.Blood samples from both pulmonary artery and vein were collected immediately before CPB （T0）,5 min （T1）,15 min （T2）,30 min （T3） and 1 hour （T4） after cardioversion.The serum levels of human neutrophilelastase （HNE）,IL-6 and IL-10 concentrations were measured,and the relative concentration of these mediators in pulmonary vein versus artery,which was expressed as PV/PA ratio,was calculated.Meanwhile,the duration of CPB,aorta blockage and tracheal intubation,the hospitalization in CCU,and use of the vasoactive agents were recorded.Results：No statistically significant differences were revealed in the terms of inflammatory mediators （HNE,IL-6 and IL-10） before CPB between two groups （P＞0.05）.After recovery of heart beating,two groups of HNE,IL-6 content in PV,PA ratio increased in varying degrees,but in S group at each time point rise extent was lower than that of P group （P＜0.01 or P＜0.05）.IL-10 in the CPB ratio also increased significantly,and S was increased significantly than that in P group,the differences were statisti