盐酸戊乙奎醚对心肺转流下心脏瓣膜置换术患者急性肺损伤的影响

目的探讨盐酸戊乙奎醚(PHC)对心肺转流(CPB)下心脏瓣膜置换术患者术后急性肺损伤(ALI)的影响。方法选择择期行CPB下心脏瓣膜置换术的风湿性心脏病患者30例,男18例,女12例,心功能NYHA分级Ⅱ或Ⅲ级,按照随机数字法分为PHC处理组(P组)和对照组(C组),每组15例。麻醉诱导前P组患者静脉注射PHC 0.03mg/kg,C组患者注射等量生理盐水。分别于麻醉诱导前(T0)、手术结束时(T_1)、术后6h(T_2)、12h(T_3)、24h(T_4)抽取血标本测定血浆IL-6、TNF-α和NF-κB等细胞因子水平;分别于T_0、T_1和T_4时监测动脉血气并计算氧合指数(OI);记录麻醉后即刻和手术结束即刻患者的肺动态顺应性参数。记录患者气管导管留置时间、ICU住院时间和术后住院时间等。结果 P组术后气管导管留置时间、ICU住院时间和术后住院时间均短于C组,但差异无统计学意义。与T_0时比较,T_1~T_4时两组血浆IL-6、TNF-α和NF-κB浓度均明显升高(P0.05);T_1~T_4时P组血浆IL-6、TNF-α和NF-κB浓度均明显低于C组(P0.05)。与T_0和T_1时比较,T4时两组OI明显降低(P0.05);T_4时P组OI高于C组,但差异无统计学意义。与麻醉后即刻比较,手术结束即刻C组肺动态顺应性明显下降(P0.05);手术结束即刻P组肺动态顺应性明显高于C组(P0.05)。结论 PHC能有效抑制CPB下心脏瓣膜手术患者的炎症反应、改善肺顺应性、改善组织氧供,促进患者的术后康复,其机制可能与PHC调控NF-κB信号通路的活性、减少IL-6和TNF-α等促炎细胞因子的释放有关。

Effects of penehyclidine hydrochloride on acute lung injury in heart valve replacement patients with car-diopulmonary bypass

Objective To investigate effects of penehyclidine hydrochloride (PHC)protects a-gainst acute lung injury (ALI)in heart valve replacement patients with cardiopulmonary bypass (CPB).Methods Thirty rheumatic heart disease patients,eighteen males and twelve females with NYHA Ⅱ or Ⅲ,with cardiac valve replacement undergoing CPB were enrolled in the study.All pa-tients were randomly divided into group P and group C (fifteen in each group).Patients in group P re-ceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to monitor the concentrations of IL-6,TNF-αand NF-κB at the following time points:before anesthesia induction (T0 ),the end of the operation (T1 ),6 hours (T2 ),12 hours (T3 )and 24 hours(T4 )postoperatively,arterial blood gas analyses were detected and oxygenation index (OI)was calculated at the time of T0 ,T1 and T4 , as well as lung dynamic compliance of patients adopt at the time of soon after anesthesia induction and the end of the operation.The outcomes included duration of intubation (DOI),length of intensive care unit stay (LOI)and length of hospital stay after the surgery (LOH).Results The DOI,LOI and LOH in group P were shorter than those in group C,but there was no statistical significance between groups.The plasma levels of IL-6,TNF-α and NF-κB were higher at T1-T4 than T0 in both groups (P <0.05),and those in group P were statistically lower than group C at T1-T4 (P <0.05).The val-ues of OI at T0 and T1 were obviously lower than T4 in both groups (P <0.05),and that in group P was slightly higher than group C at T4 but without statistical significance.The lung dynamic compli-ance of patients in group P at the end of operation was obviously higher than that in group C (P <0.05).Conclusion PHC inhibits systemic inflammatory response,improves lung compliance,amel-iorates tissue oxygen supply and encourages postoperative rehabilitation in valve heart replacement pa-tients with CPB,and its mechanisms is relevant to the regulation of NF-κB signal way on the produc-tion of such proinflammatory cytokines as IL-6 and TNF-α.