机械通气对体外循环术后炎症反应的影响

目的：探讨体外循环（CPB）术后不同肺通气策略对肌体炎症反应的影响。方法：行室间隔缺损修补术的患者30例，随机分为两组，传统通气组（H组）和保护性肺通气组（L组），于麻醉诱导后、CPB前、CPB结束即刻、CPB结束后6小时取静脉血样测IL-6和IL-8。结果：在体外循环前H组与L组在IL-6与IL-8水平无差异，CPB结束即刻两组的IL-6与IL-8水平均明显升高，而两组间亦无差异性。在CPB结束后6小时两组的IL-6与IL-8水平继续升高，H组升高的更明显，L组仅轻度升高。结论：保护性肺通气策略可以降低体外循环术后的全身炎症反应，有利于患者肺功能的恢复。

The effects of different ventilatory settings on systemic inflammatory responses after cardiopulmonary bypass

Objective:To study whether mechanical ventilation modifies the inflammatory responses in patients undergoing CPB for cardiac surgery.Methods:30 patients with Ventricular Septal Defect(VSD) undergoing CPB for VSD repair were randomized to the group H and group L. Group H received conventional mechanical ventilation with V_ (T) =10 to 12 ml/kg ideal body weight and low end-expiratory pressure. Group L received a new protective mechanical ventilation strategy with V_ (T) =8 ml/kg ideal body weight with positive end-expiratory pressure of 10 cm H_2O. IL-6, IL-8 were determined in plasma before CPB and 0, 6 h after CPB.Results:All plasma mediators increased more in Group H than Group L at the 6h after CPB, while they were same before CPB and 0 h after CPB.Conclusion:According to conventional mechanical ventilation, the protective ventilatory strategy may result in a marked reduction of systemic levels of measured inflammatory markers in patients undergoing CPB for cardiac surgery.