本文選題：體外循環(huán) + 七氟醚�。� 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:以對肺損傷的敏感的SP-A和炎癥因子IL-8、TNF-α,結合術中和術后的血流動力學及血氣參數(shù)為觀測指標,觀察缺血前期和再灌注早期吸入七氟醚對瓣膜置換術患者血清中TNF-α、IL-8和SP-A的影響和意義,研究缺血前期和再灌注早期吸入七氟醚在CPB后肺損傷的保護機制。方法:選擇擇期行二尖瓣或者主動脈瓣膜置換的患者40例,年齡30~65歲,體重47~81kg,性別不限,ASA分級II或者III級,采用隨機數(shù)字表法分為七氟醚組(S組)和對照組(C組),每組20例。兩組均采用全靜脈麻醉,S組患者在夾畢和開放升主動脈前后各吸入2%七氟醚15min,C組整個過程不吸入七氟醚。分別于切皮前(T0)、體外循環(huán)前(T1)、主動脈開放后30min(T2)、開放后2h(T3)、開放后6h(T4)、開放后24h(T5)取橈動脈血檢測動脈血氣并計算肺泡動脈血氧分壓差P(A-a)O2、氧合指數(shù)OI;并測得T0、T1、T2、T3、T4、T5的動脈血清中炎性因子白細胞介素8(Interleukin 8,IL-8)和腫瘤壞死因子α(Tumor necrosis factorα,TNF-α)的水平。在T1、T2時刻分別抽取右心室(近似肺動脈)、左心房(近似肺靜脈)血測得中性粒細胞(NEV,NEA)和肺泡表面活性物質A(SP-AV,SP-AA),計算肺動靜脈之間兩者之間的差值(NEV-A,SP-AV-A),反映了肺內凈生成了NE和凈釋放SP-A。結果:1、兩組患者體重、年齡、CPB時間、主動脈阻斷時間、機械通氣時間、ICU停留時間未見明顯差異(P0.05)。兩組各個時刻的MAP和HR無明顯差異(P0.05)。2、與C組比較,S組在T2、T3、T4時P(A-a)O2、IL-8和TNF-α明顯低于C組,OI明顯高于C組(P0.05),在T0、T1、T5時兩組P(A-a)O2、OI、IL-8和TNF-α差異無統(tǒng)計學意義(P0.05);與T0相比,兩組P(A-a)O2、IL-8和TNF-α在T1時開始升高,T3時達到高峰后降低,OI在T1開始降低,T3時達到最低點后回升(P0.05)。3、與C組比較,在T1時兩組NEV、NEA、SP-AV、SP-AA沒有明顯差異(P0.05),在T2時S組明顯低于C組(P0.05);與T1時相比,T2時刻兩組NEV、NEA、SP-AV、SP-AA都明顯升高(P0.05)。結論:1、與不吸入七氟醚相比,缺血前期和再灌注早期吸入七氟醚能降低炎癥因子TNF-α、IL-8的水平,減少SP-A的釋放入血。2、與不吸入七氟醚相比,七氟醚組患者的保持了較低的P(A-a)O2和較高的OI,可能減輕CPB后肺損傷,有利于肺保護。
[Abstract]:Objective: to observe the sensitivity of SP-A and IL-8 TNF- 偽 to lung injury, combined with hemodynamics and blood gas parameters during and after operation. To observe the effect and significance of inhaling sevoflurane before ischemia and early reperfusion on TNF- 偽 IL-8 and SP-A in serum of patients undergoing valvular replacement, and to study the protective mechanism of sevoflurane inhalation before ischemia and early reperfusion on lung injury after CPB. Methods: forty patients with mitral valve or aortic valve replacement, aged 30 to 65 years, weighing 4781 kg, were randomly divided into sevoflurane group (group S) and control group (group C, n = 20). Both groups were treated with total intravenous anaesthesia before and after clamping and opening of ascending aorta. The patients in group C did not inhale sevoflurane during the whole process of inhaling 2% sevoflurane for 15 min before and after clamping and opening the aorta. The radial artery blood was collected to detect arterial blood gas and calculate the oxygen pressure difference (PA-aO _ 2) of alveolar artery, oxygen index Oi, and the arterial blood level of T0 T _ (1) T _ (2) T _ (2) T _ (3) T _ (3) T _ (3) T _ (3) T _ (3) T _ (3) T _ (5), the arterial blood of T0 T _ (1) T _ (1) T _ (2) T _ (3) T _ (3) T _ (4) T _ (5), the arterial blood level of T0 T _ (1) and T _ (3) T _ (3) T _ (4) T _ (5) were measured. The levels of Interleukin-8 (IL-8) and tumor necrosis factor 偽 -Tumor necrosis factor 偽 (TNF- 偽) were measured. The right ventricle (near pulmonary artery, left atrial neutrophil nevo nea) and alveolar surfactant Agna were drawn at T 1 and T 2 to calculate the difference between the pulmonary arteriovenous and pulmonary arteries and veins, which reflects the intrapulmonary neophysiological changes in neutrophil nevnea and alveolar surfactant SP-AAA. NE and net release SP-A. Results there was no significant difference in weight, age, CPB time, aortic occlusion time, mechanical ventilation time and ICU stay time between the two groups (P 0.05). There was no significant difference in MAP and HR between the two groups at different time points (P 0.05). There was no significant difference in MAP and HR between group C and group C (P 0.05). Compared with group C, there was no significant difference in IL-8 and TNF- 偽 between the two groups at T2T3T4 and TNF- 偽, and there was no significant difference between the two groups at T0 / T1T5, compared with T0. The levels of IL-8 and TNF- 偽 in both groups began to increase at T1 and reached the peak at T1, and then decreased at the beginning of T _ 1 and reached the lowest point when T _ 1 began to decrease, and then rose up to P _ (0.05) O 路3, compared with those in group C, and compared with those in group C, the levels of TNF- 偽 and TNF- 偽 increased. There was no significant difference in SP-AVSP-AA between the two groups at T1, but at T2, the level of SP-AVSP-AA in group S was significantly lower than that in group C (P0.05A), and that in the two groups at T _ 1 and T _ 2 was significantly higher than that in group C (P 0.05). Conclusion compared with those without sevoflurane, inhaling sevoflurane before ischemia and early reperfusion can reduce the level of inflammatory factor TNF- 偽 and IL-8 and decrease the release of SP-A into blood. The patients in sevoflurane group maintained lower P(A-a)O2 and higher OI, which may reduce lung injury after CPB and be beneficial to lung protection.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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