【摘要】 目的探讨盐酸戊乙奎醚对体外循环下心脏瓣膜置换术肺功能的保护作用。方法选择2012年6月至2014年6月我院接诊的100例需行心脏瓣膜置换术的患者进行研究。随机分为观察组和对照组各50例。观察组患者麻醉诱导时推注0.02 mg/kg盐酸戊乙奎醚,体外循环预充液加入0.04 mg/kg盐酸戊乙奎醚。对照组患者麻醉诱导时推注等量生理盐水,体外循环预充液加入等量生理盐水。比较两组患者麻醉切皮前(T1)、CPB开始后30 min(T2)、CPB开始后1 h(T3)、CPB开始后1.5 h(T4)时间点的白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、阻力指数(RI)和肺泡动脉氧分压差[P(A-a)DO2]。结果两组患者在T1时的IL-6、TNF-α、RI和P(A-a)DO2指标比较差异均无统计学意义(P>0.05);观察组患者T2、T3、T4时间点的IL-6、TNF-α、RI和P(A-a)DO2均低于对照组,二者比较差异均有统计学意义(P<0.05);观察组的住院时间、拔引流管时间和ICU治疗时间均短于对照组,肺部感染发生率低于对照组,差异均有统计学意义(P<0.05)。结论盐酸戊乙奎醚对体外循环下心脏瓣膜置换术肺功能的保护作用良好,能显著改善患者的肺功能,值得临床推广。更多还原

【Abstract】 Objective To investigate the protective effects of hydrochloric acid penehyclidine on lung function in heart valve replacement surgery under cardiopulmonary bypass(CPB). Methods One hundred patients with heart valve replacement surgery under cardiopulmonary bypass from June 2012 to June 2014 in our hospital were enrolled in the study. They were divided randomly into the observation and control groups, with 50 patients in each group. The observation group was given 0.02 mg/kg hydrochloride acid penehyclidine in induction of anesthesia and0.04 mg/kg hydrochloric acid penehyclidine as CPB priming solution. The control group was given the same amount of physiological saline in induction of anesthesia and physiological saline as CPB priming solution. Interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), resistance index(RI) and alveolo-arterial oxygen partial pressure difference[P(Aa)DO2] at anesthesia before skin incision(T1), 30 minutes after the onset of CPB(T2), one hour after the onset of CPB(T3), 1.5 hours after the onset of CPB(T4) were compared between the two groups. Results There was no significant difference between the control group and the observation group in IL-6, TNF-α, RI and P(A-a)DO2at T1(P>0.05), but these indexes at T2, T3, T4 were found significantly lower in the observation group than the control group(P<0.05). The length of hospital stay, extubation time, and duration in ICU were all significantly shorter in the observation group than the control group, with statistically significant differences(P<0.05). Conclusion Hydrochloric acid penehyclidine has significant protective effects on lung function in heart valve replacement surgery under CPB. It can significantly improve the patient’s lung function and is worthy of promotion in clinic.更多还原