【摘要】：目的：探討前列地爾對(duì)體外循環(huán)下心臟瓣膜置換術(shù)患者肺損傷的保護(hù)作用 方法：選擇河北醫(yī)科大學(xué)第二醫(yī)院心臟外科在體外循環(huán)條件下心臟瓣膜置換術(shù)的患者30例，隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組各15例病人,兩組病人的年齡、體重、性別比例、心功能、左室射血分?jǐn)?shù)無(wú)顯著差異(P＞0.05)。實(shí)驗(yàn)組：在麻醉誘導(dǎo)后5min由中心靜脈泵入前列地爾2ng/Kg.min,直至手術(shù)結(jié)束；對(duì)照組不予此處理。兩組分別在下列時(shí)間點(diǎn)采集橈動(dòng)脈血標(biāo)本：(1)麻醉誘導(dǎo)后5min（切皮前）(T1)；(2)停體外循環(huán)后2小時(shí)(T2)；(3)停體外循環(huán)后4h(T3)；(4)體外循環(huán)后12小時(shí)（T4）用ELISA法檢測(cè)血漿TNF-a，IL-6，IL-8的含量。測(cè)動(dòng)脈血氧分壓（PaO2），二氧化碳分壓(PaCO2)和吸入氧濃度（FiO2）以計(jì)算評(píng)估氧合指數(shù)（OI）和呼吸指數(shù)（RI）。 結(jié)果：1兩組間患者炎癥因子IL-6,IL-8及TNF-a的含量及呼吸功能指標(biāo)氧合指數(shù)OI以和呼吸指數(shù)RI在T1時(shí)點(diǎn)均無(wú)顯著差異(P0.05)。2IL-6的變化： 對(duì)照組與實(shí)驗(yàn)組在T2-T4時(shí)點(diǎn)的IL-6濃度與術(shù)前T1時(shí)點(diǎn)相比明顯升高（P0.01），實(shí)驗(yàn)組在體外循環(huán)后T2-T4時(shí)點(diǎn)的IL-6血漿濃度低于對(duì)照組（P0.05）3IL-8的變化： 對(duì)照組與實(shí)驗(yàn)組在T2-T4時(shí)點(diǎn)的IL-8濃度與術(shù)前T1時(shí)點(diǎn)相比明顯升高（P0.01），實(shí)驗(yàn)組在體外循環(huán)后T2-T4時(shí)點(diǎn)的IL-8血漿濃度低于對(duì)照組（P0.05）4TNF-a的變化： 對(duì)照組與實(shí)驗(yàn)組在T2-T4時(shí)點(diǎn)的TNF-a濃度與術(shù)前T1時(shí)點(diǎn)的血漿濃度相比明顯升高（P0.01），實(shí)驗(yàn)組在體外循環(huán)后T2-T4時(shí)點(diǎn)的TNF-a血漿濃度低于對(duì)照組（P0.05）5氧合指數(shù)OI的變化比較： 兩組患者OI在體外循環(huán)前T1時(shí)點(diǎn)無(wú)差異(P0.05),兩組在體外循環(huán)后，T2,T3,T4時(shí)點(diǎn)與術(shù)前相比OI值下降（P0.01），實(shí)驗(yàn)組在T2,T3,T4各時(shí)點(diǎn)OI值均高于對(duì)照組（P0.05）。6患者RI值比較： 兩組患者RI在體外循環(huán)前T1時(shí)點(diǎn)無(wú)差異(P0.05)；兩組在體外循環(huán)后T2-T4各時(shí)點(diǎn)與術(shù)前T1時(shí)點(diǎn)相比明顯升高（P0.01），實(shí)驗(yàn)組在T2，T3，T4時(shí)點(diǎn)RI值低于對(duì)照組（P0.05）。 結(jié)論：CPB可以導(dǎo)致機(jī)體發(fā)生炎癥反應(yīng)。在CPB過程中應(yīng)用前列地爾可抑制炎癥因子的產(chǎn)生,降低血漿TNF-a，IL-6，IL-8水平，減輕肺損傷,對(duì)體外循環(huán)下心臟瓣膜置換術(shù)患者具有較好的肺保護(hù)作用。
[Abstract]:Objective: to investigate the protective effect of alprostadil on lung injury in patients undergoing cardiopulmonary bypass (CPB). There was no significant difference in age, body weight, sex ratio, cardiac function and left ventricular ejection fraction between the two groups (P > 0.05). Experimental group: after anesthesia induction, 5min was pumped into alprostadil 2 ng / kg 路min by central vein until the end of operation, but not in control group. The blood samples of radial artery were collected at the following time points: (1) after anesthesia induction 5min (before skin incision) (T1); (2) 2 hours after cardiopulmonary bypass (T2); (3), 4 hours after cardiopulmonary bypass (T3); (4) and 12 hours after cardiopulmonary bypass (T4), the level of IL-8 in plasma was detected by ELISA method. Arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and inhaled oxygen concentration (FiO2) were measured to evaluate the oxygenation index (OI) and respiratory index (RI). Results there was no significant difference between the two groups in the content of IL-6, IL-8 and TNF-a and respiratory function index (Oi) and respiratory index (RI) at T1 (P0.05). 2IL-6: control group and experimental group at T2-T4 time. The concentration of IL-6 was significantly higher than that of preoperative T1 (P0.01). The concentration of IL-6 in experimental group at T2-T4 time was lower than that in control group (P0.05) 3IL-8. The IL-8 concentration in control group and experimental group at T2-T4 time was lower than that in control group at T1 time before CPB. Compared with the control group (P0.01), the plasma concentration of IL-8 in the experimental group was lower than that in the control group (P0.05) at the time of T2-T4: the TNF-a concentration of the control group and the experimental group at the time of T2-T4 was significantly higher than that of the control group at T1 time before cardiopulmonary bypass. The plasma concentration of TNF-a in the experimental group was lower than that in the control group (P0.05) at T2-T4 point after CPB (P0.01). There was no difference between the two groups at T1 time before CPB (P0.05), and there was no significant difference between the two groups in T2T3T3 T4 after cardiopulmonary bypass (P05). The OI value of the experimental group was higher than that of the control group (P0.05) at each time point (P0.01). There was no difference between the two groups in RI at T1 time before CPB (P0.05). After cardiopulmonary bypass (CPB), T2-T4 increased significantly at each time point compared with preoperative T1 time point (P0.01), and the RI value of experimental group was lower than that of control group at T2T3T4 time point (P0.05). Conclusion: CPB can induce inflammatory reaction in the body. Alprostadil can inhibit the production of inflammatory factors, decrease the level of IL-6 and IL-8 in plasma TNF-a, alleviate lung injury, and has a better lung protective effect on patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R654.2

【引證文獻(xiàn)】

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1 尹思敏;鄒治木;楊磊;趙啟鄒;聶彩霞;何繼竹;;1476份前列地爾注射液超說明書用藥醫(yī)囑調(diào)查[J];中國(guó)醫(yī)院用藥評(píng)價(jià)與分析;2017年02期

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本文編號(hào)：2145596