肺动脉灌注在体外循环中对血氧合指数及支气管灌洗液细胞因子的影响

目的观察低温肺保护液肺动脉灌注在体外循环心脏直视手术中对血氧合指数及支气管肺泡灌洗液细胞因子的影响，探讨肺动脉灌注对减轻肺损伤的生物学机制。方法选择30例重度肺动脉高压先心病患者，随机分为对照组和肺保护组，每组15例。肺保护组，体外循环术中一次性从肺动脉灌注低温肺保护液，对照组未行肺动脉灌注。分别于麻醉诱导前（T1）、体外循环结束（T2）、手术结束（T3）和术后6h（T4）测算氧合指数（PaO2／FiO2）。收集手术结束时支气管肺泡灌洗液，检测其中肿瘤坏死因子-d（TNF—α）和白细胞介素-6（IL-6）。结果两组一般资料差异无统计学意义（P〉0．05）；肺保护组患者体外循环结束、手术结柬、术后6h的氧合指数分别为（421±31）、（382±41）和（370±39）mmHg，明显高于对照组的（340±33）、（321±38）和（315±41）mmHg（P〈0．05）。支气管肺泡灌洗液的TNF—α和IL-6水平肺保护组分别为（0．985±0．378）、（156．736±52．485）μg／L，低于对照组的（15．589±6．385）、（735．967±83．485）μg／L（P〈0．01）。结论肺动脉灌注低温肺保护液不仅可以改善氧合，同时抑制支气管肺泡灌洗液中的TNF—α和IL-6的释放，减轻肺损伤，改善术后肺功能。

Effect of pulmonary artery perfusion on the blood oxygenation index and bronchoalveolar lavage fluid Cytokine during cardiopulmonary bypass

Objective To observe the effects of pulmonary artery perfusion with hypothermie protective solution on the blood oxygenation index and brochoalveolar lavage fluid in cardiopulmonary bypass patients, and investigate the biological mechanism of protective pulmonary artery perfusion in relieving lung injury. Methods 30 patients with congenital heart disease and severe pulmonary hypertension were divided into the control group （n= 15 ） and the protective group （n=15）. The patients in the control group were performed using routine techniques, and in the protective group patients pulmonary artery were infused with 4 ℃ protective solution during CPB. Pulmonary functions were measured before induction（T1）, at the end of CPB（T2） and at 0（T3）, 6 h（T4） after surgery 30 rain. Tumor necrosis factor-α（TNF-α）, interleukin-6（IL-10） in bronchial alveolar lavage fluid were measured. Results The PaO2/FiO2 in the lung perfusion group were （421±31）, （382±41）, （370±39）mm Hg（1 mm Hg= 0.133 kPa）, significantly higher than （340±33）, （321±38）, （315±41）mm Hg in the control group at the end of CPB, and at 0 h, 6 h after surgery. The plasma levels of TNF-α and IL-6 in the protective group were significantly lower than the control group （P〈0.01）. Conclusion Perfusion with hypothermic protective solution to pulmonary artery during CPB can not only improve oxygenation, but also inhibit the releases of TNF-α, IL-6 in bronchial alveolar lavage fluid and reduce lung injury and improve pulmonary function.