【摘要】 目的探讨零平衡超滤(Z-BUF)对体外循环肺损伤的保护作用。方法选择40例心脏瓣膜置换术患者,随机分为超滤组(20例)和对照组(20例)。2组麻醉方法、手术方式和体外循环技术均相同。超滤组在体外循环(CPB)开始1 min时实施Z-BUF,输入林格氏液,控制超滤量为35 ml/kg,维持滤出液和输入液量平衡,持续40 min。对照组作常规体外循环。分别于CPB前、CPB停止即刻、术后2 h、6 h2、4 h采集动脉血,应用双抗体夹心ELISA法测定血浆肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、白介素-10(IL-10),测定结果用Hct校正。计算呼吸指数(RI)和肺泡氧合指数(OI)。结果 2组患者围术期一般情况比较差异无统计学意义。2组患者TNF-αI、L-6和IL-10在CPB停机后明显升高,术后2 h达高峰,随后逐渐下降,对照组术后24 h仍明显高于CPB前水平,超滤组明显低于对照组,差异有统计学意义(P<0.05)。2组患者呼吸指数和肺泡氧合指数(OI)CPB后比麻醉诱导时增高,对照组升幅明显高于超滤组(P<0.05)。结论体外循环中采用零平衡超滤可改善肺功能,抑制炎症因子IL-6和TNF-α的产生,并能促进抗炎因子IL-10的释放,从而减轻体外循环后肺损伤和通气功能障碍,保护并改善术后肺功能。更多还原

【Abstract】 Objective To evaluate the protection of lower volume ultrafiltration on pulmonary tissue during cardiopulmonary bypass(CPB).MethodsForty patients undergone open-heart surgery under CPB were evaluated in this study.The patients were randomly divided into two groups: Ultrafiltration group(UF group) and control group(C group).The UF group were received Ultrafiltration as the way of pulmonary protection.Interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),alveolar oxygenation index(OI),airway peak pressure and plateau pressure were recorded perioperatively between two groups.Respiratory index(RI) and pulmonary alveoli oxygenation index(OR) were calculated.ResultsThe plasma levels of IL-6 and TNF-α in UF group were significantly lower than that of the C group(P<0.05).IL-10 in UF group increased compared with C group(P<0.05).OI,airway peak pressure and plateau pressure in control group were significantly higher(P<0.05) than that of UF group.ConclusionThe results demonstrateds that IL-6,TNF-α,IL-10 could play important roles in lung injury in CPB and the ultrafiltration could protect pulmonary tissiue.更多还原