雾化吸入伊洛前列素在体外循环心脏手术后肺保护的临床研究

目的探讨雾化吸入伊洛前列素在体外循环心脏手术后肺保护的应用价值。方法选择体外循环下心脏手术患者150例，随机分为给药组及对照组，每组75例。给药组患者在手术开始时吸入15μg伊洛前列素，在吸药前（T1）、体外循环后（T2）、术后24h（乃）时点，通过漂浮导管采取两纽混合静脉血3向检测IL-6、IL-8的含量，并进行混合静脉血氧饱和度检测及血气分析。结果两组IL-6、IL-8浓度在他、13时点较T1时增高，差异有统计学意义（p〈0．05）。但对照组IL-6、IL-8浓度在他、T3时点高于给药组，差异有统计学意义（P〈0．05）。给药组混合静脉血氧饱和度和氧合指数在T2、T3时点高于对照组，差异有统计学意义（P〈0．05）。结论体外循环心脏手术后IL-6、IL-8显著增加。雾化吸入伊洛前列素显著减少体外循环后IL-6、IL-8的释放，提高混合静脉血氧饱和度和氧合指数，减轻术后早期肺炎性反应、保护肺功能。

CLINICAL STUDY OF THE EFFECT OF INHALED ILOPROST ON PULMONARY PROTEC- TION IN OPEN- HEART SURGERY

Objective To observe pulmonary protection of iloprost in open - heart surgery. Methods 150 patients underwent open - heart surgery were selected to randomly divided into the drug group （ n = 75 ） and the control group （n = 75）. In the begining of the surger, 15 μg iloprost were nebulized and inhaled to ventilation circuit, in the drug group. Mixed venous blood samples of 3 ml were extracted at three time courses through Swan - Ganz, which were after tracheal intubation （ T1 ） after cardiopulmonary bypass （ CPB ） （ T2 ）, 24h after operation （ T3 ）, to analyze concentrations of interleukin （ IL - 6, IL - 8 ）, mixed venous oxygenmonitor and blood gas analysis in the two groups, and postoperative 24 h, postoperative 72 h on chest radiograph and imaging contrast. Results In CV group and PV group, concentrations of IL -6 and IL -8 at T2 and T3 were significantly increased as compared with those at T1, the difference has statistics meaning（p 〈 0. 05 ）. Concentrations of IL -6 ,IL -8 at T2 and T3 were significantly higher in the control group than in the drug group, the difference has statistics meaning（p 〈 0.05 ）. Mixed venous oxygen satu- ration and Oxygenation index were significantly higher in the drug group than in the control group, the difference has statistics meaning（p 〈 0.05 ）. Conclusion Concentrations of IL - 6, IL - 8 are increased during and after open - heart surgery. Inhaled iloprost can decrease the release of IL- 6 ,IL- 8 during CPB and increase mixed venous oxygen satura- tion and Oxygenation index, and inhibit early post -operational pneumonia reaction to protect lung function.