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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (18) : 2211 -2216. doi: 10.3877/cma.j.issn.1674-0785.2017.18.001

所属专题: 文献

临床论著

七氟醚对体外循环心脏换瓣手术患者血清内皮素-1、一氧化氮水平和肺功能的影响
吕洁萍1,(), 田首元1, 聂丽霞1, 郝倩2, 周莉3   
  1. 1. 030001 太原,山西医科大学第一医院麻醉科
    2. 314000 浙江省嘉兴市第二医院麻醉科
    3. 037008 山西省大同市第三人民医院麻醉科
  • 收稿日期:2017-01-11 出版日期:2017-09-15
  • 通信作者: 吕洁萍
  • 基金资助:
    山西省应用基础研究自然科学基金项目(201601D102068)

Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Jieping Lyu1,(), Shouyuan Tian1, Lixia Nie1, Qian Hao2, Li Zhou3   

  1. 1. Department of Anesthesiology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
    2. Department of Anesthesiology, the Second Hospital of Jiaxing, Jiaxing 314000, China
    3. Department of Anesthesiology, the Third Hospital of Datong, Datong 037008, China
  • Received:2017-01-11 Published:2017-09-15
  • Corresponding author: Jieping Lyu
  • About author:
    Corresponding author: Lyu Jieping, Email:
引用本文:

吕洁萍, 田首元, 聂丽霞, 郝倩, 周莉. 七氟醚对体外循环心脏换瓣手术患者血清内皮素-1、一氧化氮水平和肺功能的影响[J]. 中华临床医师杂志(电子版), 2017, 11(18): 2211-2216.

Jieping Lyu, Shouyuan Tian, Lixia Nie, Qian Hao, Li Zhou. Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(18): 2211-2216.

目的

探讨在缺血再灌注早期应用七氟醚对体外循环心脏换瓣手术患者肺功能和血清内皮素-1(ET-1)、一氧化氮(NO)水平的影响。

方法

择期行瓣膜置换术的风湿性心脏病患者40例随机分为对照组(C组)和七氟醚组(S组),每组20例。两组均采用全静脉麻醉维持,S组在阻断升主动脉前吸入2%七氟醚15 min,阻断升主动脉后继续经膜式氧合器吸入2%七氟醚15 min;开放升主动脉前15 min经膜肺吸入2%七氟醚预充,开放升主动脉后持续吸入2%七氟醚15 min。C组不吸入七氟醚,其他处理同S组。时点界定为:T0(麻醉后切皮前)、T1(转机开始前即刻)、T2(停机即刻)、T3(停机后2 h)、T4(停机后6 h)、T5(停机后24 h)。分别在T0、T2、T3、T5抽取桡动脉血测定血清ET-1、NO水平。在T1、T2时点分别抽取肺动脉、肺静脉血测定其中性粒细胞计数、肺泡表面活性物质A(SP-A)浓度并计算二者差值。分别在T0、T2、T3、T4、T5时间点进行动脉血气分析,并计算氧合指数(OI)、肺泡-动脉氧分压差〔P(A-a)O2〕、肺静态顺应性(Cst)。

结果

①S组ET-1水平(pg/ml)在T2(6.6±1.8)、T3(5.9±1.4)、T5(4.3±1.2)时点较T0(2.2±1.5)明显升高(P<0.05);C组ET-1水平(pg/ml)在T2(7.9±0.7)、T3(7.1±1.3)、T5(5.8±0.9)时点较T0(2.3±1.1)明显升高(P<0.05);S组ET-1水平在T2、T3、T5时点较C组明显降低(P<0.05)。S组NO水平(nmol/ml)在T2(8.6±1.8)、T3(8.2±1.4)、T5(6.9±1.7)时点较T0(5.9±1.2)明显升高(P<0.05);C组NO水平(nmol/ml)在T2(7.3±1.1)、T3(7.0±1.1)、T5(6.1±1.4)时点较T0(5.1±0.8)明显升高(P<0.05);S组NO水平在T2、T3、T5时点较C组明显升高(P<0.05)。②两组T2时点肺动脉、肺静脉血中性粒细胞计数及其差值均较T1时明显增加(P<0.05);T2时点肺动脉、肺静脉血中性粒细胞计数及其差值S组明显少于C组(P<0.05)。两组T2时点肺动脉、肺静脉血SP-A浓度及其差值均较T1时明显增加(P<0.05);T2时点肺动脉、肺静脉血SP-A浓度及其差值S组明显少于C组(P<0.05)。③两组P(A-a)O2在T2、T3、T4、T5各时点较T0均明显升高(P<0.05);两组OI在T2、T3、T4、T5各时点较T0均明显降低(P<0.05);两组Cst在T2、T3、T4各时点较T0均明显降低(P<0.05)。S组在T2、T3、T4各时点P(A-a)O2明显低于C组(P<0.05),OI、Cst S组明显高于C组(P<0.05)。

结论

体外循环心脏换瓣手术中患者肺功能受损且血清ET-1、NO水平升高;在缺血及再灌注早期吸入2%七氟醚,可缓解这种异常,改善肺功能。

Objective

To evaluate the effect of sevoflurane inhalation in the early stage of ischemia and reperfusion on pulmonary function and plasma levels of endothelin-1 (ET-1) and nitric oxide (NO) in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).

Methods

Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into two groups (n=20 each): control group (group C) and sevoflurane group (group S). All patients were treated with total intravenous anesthesia. In group S, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and before and after the ascending aorta was opened. Sevoflurane inhalation was not given in group C. The time points used were after anesthesia and before skin incision (T0), immediately before CPB (T1), immediately after CPB (T2), 2 h after CPB (T3), 6 h after CPB (T4), and 24 h after CPB (T5). At T0, T2, T3, and T5, radial artery blood was obtained to detect plasma levels of ET-1 and NO. At T1 and T2, pulmonary artery and pulmonary vein blood was obtained to detect neutrophil count and SP-A to calculate the difference between the vein and artery. At T0, T2, T3, T4, and T5, arterial blood gas was measured to calculate P(A-a)O2, OI, and Cst.

Results

Plasma levels of ET-1 (pg/mL) were significantly higher at T2 (6.6±1.8), T3 (5.9±1.4), and T5 (4.3±1.2) than at T0 (2.2±1.5) in group S (P<0.05), and at T2 (7.9±0.7), T3 (7.1±1.3), and T5 (5.8±0.9) than at T0 (2.3±1.1) in group C (P<0.05); compared with group C, e plasma ET-1 levels were significantly decreased in group S at T2, T3, and T5 (P<0.05). Plasma levels of NO (nmol/mL) were significantly higher at T2 (8.6±1.8), T3 (8.2±1.4), and T5 (6.9±1.7) than at T0 (5.9±1.2) in group S (P<0.05), and at T2 (7.3±1.1), T3 (7.0±1.1), and T5 (6.1±1.4) than at T0 (5.1±0.8) in group C (P<0.05); compared with group C, plasma NO levels were significantly higher in group S at T2, T3, and T5 (P<0.05). The neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T2 than at T0 in both groups (P<0.05); compared with group C, the neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T2 (P<0.05). SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T2 than at T0 in both groups (P<0.05); compared with group C, SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T2 (P<0.05). P (A-a)O2 was significantly higher at T2, T3, T4, and T5 than at T0 in both groups (P<0.05). OI was significantly lower at T2, T3, T4, and T5 than at T0 in both groups (P<0.05). Cst was significantly decreased at T2, T3, and T4 than at T0 in both groups (P<0.05). Compared with group C, P(A-a)O2 was significantly decreased in group S at T2, T3, and T4 (P<0.05), and OI and Cst were significantly higher in group S at T2, T3, and T4 (P<0.05).

Conclusion

Pulmonary injury and ET-1/NO disorder may occur during cardiac valve replacement with CPB, which can be improved by sevoflurane inhalation in the early stage of ischemia and reperfusion.

表1 两组患者一般资料及术中情况比较(±s
表2 两组患者各时点血清ET-1、NO水平的比较(±s
表3 两组患者在T1、T2时点肺静脉(V)、肺动脉(A)血中性粒细胞计数、SP-A浓度及其静-动脉差值的比较(±s
表4 两组患者各时点P(A-a)O2、OI、Cst的比较(±s
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