糖皮质激素对心脏直视手术围术期中性粒细胞CD11b表达和肺换气功能的影响

目的:研究糖皮质激素对心脏直视手术围术期肺动脉血中性粒细胞CD11b表达和肺换气功能的影响。方法:24例拟择期行心脏瓣膜置换术的患者,随机分为3组:对照组、琥珀酰氢化考的松组(HSS组)、甲泼尼松龙琥珀酸钠组(MPS组)。于体外循环(CPB)前(T1)、上下腔静脉开放后5min(T2)、1h(T3)、2h(T4),18h(T5)采集患者肺动脉血,行血常规中性粒细胞计数和流式细胞仪中性粒细胞CD11b活性测定。于T1、T3、T4、T5时点行动脉血气分析,并计算呼吸指数(Spiro-index,RI)、氧合指数(oxygenation-index,OI)、a/A(ratioofPaO2toPAO2)。结果:对照组肺动脉血中性粒细胞CD11b活性表达于T2、T3时点显著强于MPS组(P<0.05)。对照组RI显著高于HSS组和MPS组(P<0.01),对照组OI、a/A显著低于HSS组和MPS组(P<0.05)。结论:心脏瓣膜置换术的患者术前静脉给予甲泼尼松龙琥珀酸钠(10mg/kg),可抑制肺动脉血中性粒细胞CD11b活性表达,并可改善患者CPB后肺换气功能。

The Influence of Glucocorticoid on the CD11b Neutrophil Integrin and the Function of Lung Ventilation during Open Heart Surgery

Objective: To research the influence of glucocorticoid on the CD1 1b neutrophil intergrin in pulmonary arterial blood and the function of lung venti lation during open heart surgery. Methods: Twenty-four patients undergoing card ia valve replacement operations were randomly allocated to three groups (n=8 eac h): control group, hydrocortisone group and methylprednisolone group. Pulmonary arterial blood samples were taken through Swan-Ganz catheter for the measuremen ts of neutrophil cell count and CD11b expression before CPB (T1) and 10 minutes (T2), 1 hour (T3), 2 hours (T4), 18 hours (T5) after superior veno cava and infe rior veno cava declamping. Arterial blood gases were analyzed and Spiro-index ( RI), Oxygenation-index (OI) and ratio of PaO2 to PAO2 (a/A) were calculated at the same times as above except for T2. Results: The degree of CD11b expression i n control group was significantly higher than that in methylprednisolone group a t T2 and T3(P< 0.05). RI of control group was higher than hydrocortisone group and methylprednisolone group at T4(P< 0.01)and OI and a/A of control group we re less than other groups at the same time(P< 0.05). Conclusion: Methylprednis olone sodium succinate can blunt neutrophil CD11b surface glycoprotein in the pu lmonary arterial blood and improve the function of lung ventilation during cardi ac valve replacement surgery.