盐酸戊乙奎醚复合乌司他丁对体外循环心脏瓣膜置换术患者肺损伤的影响

目的 评价盐酸戊乙奎醚复合乌司他丁对体外循环(CPB)心脏瓣膜置换术患者肺损伤的影响.方法 择期行CPB心脏瓣膜置换术患者60例,年龄33～64岁,体重47～81 kg,性别不限,ASA分级Ⅱ或Ⅲ级,心功能分级Ⅱ或Ⅲ级,随机分为4组(n=15):对照组(C组)、乌司他丁组(U组)、盐酸戊乙奎醚组(P组)和盐酸戊乙奎醚复合乌司他丁组(PU组).CPB结束后30 min时,C组将PEEP增至8 cm H2O;U组、P组和PU组分别静脉注射乌司他丁2万U/kg、盐酸戊乙奎醚0.05 mg/kg、盐酸戊乙奎醚0.05 mg/kg和乌司他丁2万U/kg,然后将PEEP增至8 cm H2O.于CPB结束后30 min、3、6 h、术后12和24 h时,测定PaO2,计算氧合指数;于上述时点记录气道峰压和气道平台压,计算肺顺应性;于上述各时点采用ELISA法测定血清TNF-αIL-6、IL-8及IL-10的浓度;于CPB结束后6 h和术后12、24 h时行肺损伤评分.结果 与C组比较,U组、P组和PU组氧合指数和肺顺应性升高,肺损伤评分降低(P＜0.05或0.01);与U组和P组比较,PU组氧合指数和顺应性升高,肺损伤评分降低(P＜0.05).与C组比较,U组、P组和PU组血清TNF-α、IL-6和IL-8的浓度降低,IL-10浓度升高(P＜0.05或0.01);与U组和P组比较,PU组血清TNF-α、IL-6和IL-8的浓度降低,IL-10浓度升高(P＜0.05).U组和P组间上述标比较差异无统计学意义(P＞0.05).结论 盐酸戊乙奎醚复合乌司他丁可减轻CPB心脏瓣膜置换术患者肺损伤,其机制可能与抑制炎性反应有关.

Effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.