【摘要】：目的:在缺血早期和再灌注早期對體外循環(huán)下行心臟瓣膜置換術(shù)的患者應(yīng)用2%七氟醚,觀察七氟醚處理對中性粒細胞、IL-8、NO、ET-1及跨肺單核細胞的影響。方法:采取隨機對照的方法將40例擇期行體外循環(huán)下心臟瓣膜置換術(shù)的患者分為七氟醚組(S組)和對照組(C組),每組各20例。S組在阻斷升主動脈前15min吸入2%七氟醚持續(xù)到阻斷升主動脈后15min,開放升主動脈前吸入2%七氟醚15min持續(xù)到開放升主動脈后15min。C組不吸入七氟醚,其余處理同S組。檢測麻醉后開胸前(T1)、CPB開始時(T2)、CPB停機時(T3)、停機后2 h(T4)、停機后6h(T5)、停機后24h(T6)橈動脈血中NO、ET-1、IL-8的濃度及中性粒細胞百分比。并在T2、T3時收集肺動脈血和肺靜脈血進行單核細胞計數(shù),計算其跨肺差值。將所收集的數(shù)據(jù)進行統(tǒng)計學(xué)處理。結(jié)果:組內(nèi)比較:與T1時相比,兩組IL-8、ET-1、NO水平及中性粒細胞百分比在T2到T6時均升高(P0.05);兩組單核細胞跨肺差值在體外循環(huán)結(jié)束時均明顯升高(P0.05)。組間比較:兩組各指標在體外循環(huán)開始前(基礎(chǔ)值)無統(tǒng)計學(xué)差異(P0.05);T2到T6時S組IL-8、ET-1血清濃度及中性粒細胞百分比均低于C組(P0.05),T2到T6時S組NO血清濃度均高于C組(P0.05),體外循環(huán)結(jié)束時(T3)S組單核細胞跨肺差值明顯低于C組(P0.05)。結(jié)論:在肺缺血早期和再灌注早期給予CPB患者2%七氟醚處理,可以提高NO、降低ET-1水平,減少IL-8、中性粒細胞的產(chǎn)生,減輕單核細胞在肺內(nèi)的聚集,減輕體外循環(huán)所致的炎性損傷。
[Abstract]:Aim: to observe the effects of sevoflurane on neutrophil IL-8 and transpulmonary monocytes in patients undergoing cardiac valve replacement under cardiopulmonary bypass at the early stage of ischemia and reperfusion. Methods: 40 patients undergoing elective cardiac valve replacement under cardiopulmonary bypass were randomly divided into sevoflurane group (group S) and control group (group C). 20 patients in group S inhaled 2% sevoflurane (15min) before blocking ascending aorta. The ethers lasted until 15 min after the aortic occlusion, 2% sevoflurane 15min was inhaled before opening the ascending aorta, and no sevoflurane was inhaled in the 15min.C group after opening the ascending aorta. The other treatments were the same as group S. The concentration of NO,ET-1,IL-8 and the percentage of neutrophils in radial artery (T6) 24 hours after anesthesia were measured at the beginning (T _ 2), 2 h (T _ 4), 6 h (T _ 5) and 24 h (T _ 6) after anesthesia. Pulmonary artery blood and pulmonary vein blood were collected at T _ 2 T _ 3 for monocyte count and transpulmonary difference was calculated. The collected data are statistically processed. Results: compared with T1, the level of IL-8,ET-1,NO and the percentage of neutrophils in both groups increased from T2 to T6 (P0.05), and the transpulmonary difference of monocytes increased significantly at the end of cardiopulmonary bypass (P0.05). Comparison between the two groups: there was no significant difference between the two groups before the beginning of cardiopulmonary bypass (P05). The serum concentration of IL-8,ET-1 and the percentage of neutrophils in group S were lower than those in group C (P0.05). The serum concentration of NO in group S was higher than that in group C (P0.05). At the end of cardiopulmonary bypass (T3), the transpulmonary difference of monocytes in group S was significantly lower than that in group C (P0.05). Conclusion: 2% sevoflurane treatment in patients with CPB at the early stage of pulmonary ischemia and reperfusion can increase the level of ET-1, decrease the production of IL-8, neutrophils, reduce the accumulation of monocytes in the lung and alleviate the inflammatory injury induced by cardiopulmonary bypass.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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