氟比洛芬酯保护心肺转流术后急性肺损伤的机制研究

目的探讨氟比洛芬酯对心肺转流术导致急性肺损伤的保护作用。方法30例择期行瓣膜置换术的风湿性心脏病患者分为实验组（15例）和对照组（15例）。在体外循环心肺转流开始后，实验组单次加入氟比洛芬酯2mg／妇于体外循环机中，而对照组给予等量0．9％氯化钠注射液。采用酶联免疫吸附法分别于麻醉诱导（T1）、转流前5min（T2）、转流30min（T3）、主动脉开放后心脏复跳5min（T4）、CPB结束后1h（T5）、CPB结束后5h（T6）检测两组患者的白细胞介素6（IL-6）、IL-10、肿瘤坏死因子仅（TNF-α）和可溶性细胞间黏附分子-1（sICAM-1），并同时记录肺泡-动脉氧分压差（A-aD02）和呼吸指数（RI）。结果体外循环开始后，两组患者血IL-6、IL-10、TNF-α、sICAM-1及A-aDO2、RI均进行性升高，后逐渐下降，但仍均高于同组T1水平（P均〈0．05）。实验组IL-6、IL-10和slCAM-1水平在T3、T4、T5和T6时段与同时段对照组比较，差异均有统计学意义（P均〈0．05）。与同时段对照组比较，TNF-α水平在T4时段明显增高（P〈0．05）；A-aDO：及RI在T4、T5和T6时段均明显降低（P均〈0．05）。结论氟比洛芬酯能通过抑制IL-6、TNF-α和sICAM-1的产生，促进IL-10的释放，减轻心肺转流术后的急性肺损伤，从而保护并改善术后肺功能。

Protective mechanism of flurbiprofen axetil against acute lung injury after cardiopulmonary bypass

Objective To investigate the protective mechanism of flurbiprofen axetil against acute lung injury after cardiopulmonary bypass.Methods Thirty patients scheduled for elective valve replacement were randomly divided into experimental group(15 cases) and control group(15 cases).The patients in the experimental group received flurbiprofen axetil(2 mg /kg) after cardiopulmonary bypass began,while in the controls received equivalent amount of 0.9% NaCl instead.The levels of interleukin-6(IL-6),IL-10,tumor necrosisfactor-alpha(TNF-α) and soluble intercellular adhesion molecules 1(sICAM-1) were dynamically detected by enzyme linked immunosorbent assay during induction of anesthesia(T1),5 min before CPB(T2),30 min after CPB began(T3),5 min after aortic off-clamping(T4),1 h after CPB ended(T5) and 5 h after CPB ended(T6),and the alveolar-arterial oxygen tension difference(A-aDO2) and respiratory index(RI) were recorded at the same time in the two groups.Results After the CPB began,the levels of IL-6,IL-10,TNF-α,sICAM-1,A-aDO2 and RI increased markedly,and then decreased gradually,but were still higher than T1 in both groups(all P < 0.05).In the experimental group,the levels of IL-6,IL-10 and sICAM-1 at T3,T4,T5 and T6 were significantly different(all P < 0.05) as compared with the controls(all P < 0.05).The TNF-α at T4 was much higher(P < 0.05),and the RI and A-aDO2 were lower at T4,T5 and T6 than the control group at corresponding time points(all P < 0.05).Conclusion Flurbiprofen axetil can inhibit the production of IL-6,TNF-α and sICAM-1,promote the release of IL-10,alleviate the acute lung injury after cardiopulmonary bypass,and thereby protect the postoperative pulmonary function.