【摘要】：目的比較體外循環(huán)(CPB)期間血氧分壓控制在60、170 mmHg的心內(nèi)直視手術(shù)患者心肝腎損傷指標(biāo)、炎癥因子、氧化應(yīng)激指標(biāo)變化。方法 80例擇期行心內(nèi)直視手術(shù)患者隨機(jī)分為低氧組和高氧組各40例,低氧組、高氧組在CPB期間血氧分壓分別控制在60、170 mmHg。分別于術(shù)前及開主動(dòng)脈后30 min、2 h、6 h、24 h(T0~T4)抽取患者靜脈血,采用全自動(dòng)生化分析儀檢測血清谷草轉(zhuǎn)氨酶(AST)、谷丙轉(zhuǎn)氨酶(ALT)、堿性磷酸酶(ALP)、肌酐(Cr)、尿素氮(UN)、尿酸(UA),ELISA法檢測血清心肌肌鈣蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、C反應(yīng)蛋白(CRP)、白細(xì)胞介素6(IL-6)、腫瘤壞死因子α(TNF-α),采用試劑盒檢測血清活性氧(ROS)、丙二醛(MDA)。結(jié)果與同組T0時(shí)點(diǎn)比較,兩組T_1~T_4時(shí)點(diǎn)cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平升高(P均0.05);與高氧組比較,低氧組T2~T4時(shí)點(diǎn)cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平降低(P均0.05)。與同組T0時(shí)點(diǎn)比較,兩組T_1~T_4時(shí)點(diǎn)CRP、TNF-α、IL-6水平升高(P均0.05);與高氧組比較,低氧組T_1~T_4時(shí)點(diǎn)CRP、TNF-α、IL-6水平降低(P均0.05)。與同組T0時(shí)點(diǎn)比較,兩組T_1~T_4時(shí)點(diǎn)ROS、MDA水平升高(P均0.05);與高氧組比較,低氧組T_1~T_4時(shí)點(diǎn)ROS、MDA水平降低(P均0.05)。結(jié)論相對(duì)于高血氧分壓,心內(nèi)直視手術(shù)患者CPB期間采用低血氧分壓能夠顯著降低由CPB引發(fā)的心肝腎損傷、炎癥反應(yīng)及氧化應(yīng)激。
[Abstract]:Objective to compare the changes of heart, liver and kidney injury, inflammatory factors and oxidative stress in patients undergoing open heart surgery with 60170 mmHg partial pressure of blood oxygen during cardiopulmonary bypass (CPB). Methods 80 patients undergoing elective open heart surgery were randomly divided into hypoxia group (n = 40) and hyperoxia group (n = 40). The partial pressure of blood oxygen in hyperoxia group was controlled at 60170 mmHg. during CPB. Venous blood samples were taken before operation and 30 min,2 h, 6 h, 24 h (T0~T4), respectively. Serum glutamic oxaloacetic transaminase (AST), glutamic pyruvic transaminase (ALT), alkaline phosphatase (ALP), was detected by automatic biochemical analyzer. Serum cardiac troponin (cTnI), creatine kinase isoenzyme (CK-MB), C reactive protein (CRP), IL 6 (IL-6) was detected by creatine (Cr), urea nitrogen (UN), uric acid (UA), ELISA method. Tumor Necrosis Factor 偽 (TNF- 偽) was used to detect malondialdehyde (MDA) (MDA). In serum reactive oxygen species (ROS),) by kit. Results compared with the T0 time point of the same group, the cTnI,CK-MB,AST,ALT,ALP,Cr,UN,UA level of T_1~T_4 in the two groups was higher than that in the same group (P 0.05). Compared with hyperoxia group, the level of cTnI,CK-MB,AST,ALT,ALP,Cr,UN,UA at T2~T4 time point in hypoxia group was lower than that in hyperoxia group. Compared with T0 time point in the same group, the levels of CRP,TNF- 偽 and IL-6 at T_1~T_4 time point in both groups were higher than those in hyperoxia group, and the levels of CRP,TNF- 偽 and IL-6 at T_1~T_4 time point in hypoxia group were lower than those in hyperoxia group. Compared with the T0 time point of the same group, the ROS,MDA level of T_1~T_4 in the two groups was higher than that in the hyperoxia group, and the ROS,MDA level at the T_1~T_4 time point in the hypoxia group was lower than that in the hyperoxia group. Conclusion compared with hyperoxia, hypooxia during CPB can significantly reduce the heart, liver and kidney injury, inflammatory reaction and oxidative stress induced by CPB.
【作者單位】： 河北醫(yī)科大學(xué)第三醫(yī)院;
【基金】：河北省醫(yī)學(xué)科學(xué)研究重點(diǎn)課題(20150731)
【分類號(hào)】：R654.2

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