摘要
目的观察术中持续吸入一氧化氮(NO)对体外循环(CPB)下心脏瓣膜置换术病人炎性反应及肺功能的影响。方法42例拟在CPB下行心脏瓣膜置换术的病人,ASAⅡ或Ⅲ级,年龄35-53岁,随机分为对照组(C组)和NO组,每组21例。NO组通过肺和氧合器吸入40ppmNO。两组分别于麻醉诱导前即刻(T0)、CPB前即刻(T1)、CPB开始10min(T2)、开升主动脉前即刻(T3)、开升主动脉后10min(T4)、术毕(T5)、术后12h(T8)和术后24h(T9)取动脉血,行多核粒细胞(PMN)计数。每组随机选取10例病人,分别于T0-5时测定动脉血中性粒细胞表面CD11b表达。每组分别于T0、T5、术后4h(T6)、术后8h(T7)测动态肺顺应性(Cdyn)和肺泡-动脉血氧分压差(PA-aO2)。结果与T0时比较,C组在T1-5,时PMN计数增高,NO组在T3-5时PMN计数增高,两组均在T5时达峰值(P<0.05),C组在T2-5时PMN计数低于NO组(P<0.05)。与T0时比较,两组在T2-5时中性粒细胞表面CD11b表达增加,且均在T3时达峰值,NO组在T2-5时中性粒细胞表面CD11b表达低于C组(P<0.05)。与T0比较,两组在T5-7时PA-aO2均增加,NO组在T5-6时PA-aO2低于C组(P<0.05),Cdyn在组间及组内比较差异无统计学意义(P>0.05)。结论CPB下心脏瓣膜置换术中持续吸入NO40ppm可抑制中性粒细胞表面CD11b表达的上调,改善术后肺功能。
Objective To investigate the effects of sustained nitric oxide (NO) inhalation during operation on neutrophil CD11b expression and postoperative lung function in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB) .Methods Forty-two ASA Ⅱ or Ⅲ patients aged 35-53 yr weighing 47-69 kg undergoing cardiac valve replacement with CPB were randomly divided into 2 group:NO group(n = 21) and control group(n= 21) .In NO group the patients inhaled 40 ppm NO through the lungs and oxygenator after tracheal intubation during operation before the chest was closed. Anesthesia was induced with fentanyl 20 μg·kg-1 and pipeceuronium 0.2 mg·kg-1 maintained with isofluarane inhalation and intermittern i.v. boluses of fentanyl and pipecuronium. A total of 5 000 000 IU aprotin was given during operation. Arterial blood samples were taken before induction of anesthesia (T0, baseline), immediately before CPB (T1 ) 10 rain after CPB was started (T2 ), immediately before aortic unclamping (T3 ) ,10 min after aortic unclamping (T4 ), at the end of operation (T5 ) , 12 h and 24 h after operation (T8 ,T9) for polylmorphonuclear(PMN) counts and determination of neutrophil CD11b expression . Blood gas analysis was performed PA-a O2 was calculated and dynamic compliance of respiratory system (Cdyn) was measured before induction of anesthesia, at the end of operation and at 4 and 8 h after operation. Results PMN count significantly decreased at T2 compared to baseline and then gradually increases ( P < 0.05) , whereas in NO group there was no significant decrease in PMN count at T2. The PMN count was significantly greater in NO group than in control group at T2-5 ( P < 0.05) . CPB significantly upregulated neutrophil CD11b expression which reached at peak at T3 both groups but CD11b expression was significantly lower in NO group than in control group at T2-5 ( P < 0.05) .There was no significant change in Cdyn after operation in both group but PA-a O2 was smaller at the end of and 4h after operadon in NO group than in control group( P < 0.05). Conclusion Continuous NO inhalation during operation can significantly inhibit neutrophil CDllb expression upregulation induced by CPB and improve postoperative lung function.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第3期169-172,共4页
Chinese Journal of Anesthesiology
