长托宁对冠状动脉搭桥术心肺转流期间炎性细胞因子的影响

摘要

Objective To study the changes of inflammatory cell factor during and after cardiopulmonary bypass (CPB) and clinical effect of penehyclidine hydrochloride injection used in coronary artery bypass graft (CABG).Methods Totally 39 patients receiving CABG were divided into penehyclidine hydrochloride injection group 1,penehyclidine hydrochloride injection group 2 and control group.Before the operation,penehyclidine hydrochloride injection group 1 and penehyclidine hydrochloride injection group 2 were given 0.02-0.03mg/kg of intramuscular injection of penehyclidine.Then 24 hours and 48 hours after the operation,penehyclidine hydrochloride injection group 2 was given 0.02-0.03mg/kg of intramuscular injection of penehyclidine hydrochloride injection respectively.Thirty minutes before the operation,control group received 0.01mg/kg of intramuscular injection of atropin.Body temperature and heart rate of the patients of three groups before and 30 minutes after the injection were observed.The artery blood was picked separately before the anaesthesia induction,30 min after CPB,instantly after the operation,24 hours and 48 hours after the operation.The density of tumor necrosis factor Alpha (TNF-α),the Interleukin 6 (IL-6) and Interleukin 8 (IL-8) by using monoclone antibody enzyme-linked immunosorbent assay (ELISA) were observed.Incidence rate of X sternum pneumonia,support time of breathing machine and resident time in ICU after the operation were analyzed.Results Thirty min after the injection,Heart rate of patients of control group increased,which was higher than that of penehyclidine hydrochloride injection group 1 and penehyclidine hydrechloride injection group 2.After CPB,the density of inflammatory cell factor of patients from control groups all went up clearly compared with that before the anaesthesia induction,reaching the highest when CPB was done,going down gradually after the operation.24 and 48 hours after the operation it was remaining higher than that before the operation[TNF-a:(12.2 ±2.1)ng/L vs (19.4±l.7)ng/L,(26.3 ±2.5)ng/L,(19.1 ±1.7)ng/L,(16.3±1.3) ng/L,P ＜ 0.05 ].The highest levels of penehyclidine hydrochloride injection group 1 and penehyclidine hydrochloride injection group 2 were lower than those of control Group significantly.After the operation,the support time of breathing machine and the resident time in ICU of penehyclidine hydrochloride injection group 1 and Penehyclidine hydrochloride injection group 2 were lower than those of control group significantly[( 10.6 ± 3.7) h,(9.6 ±7.7)h vs (11.8 ±7.7)h; (3.5 ±l.9)h,(3.0±1.8)h vs (3.9 ±1.8)h,P＜0.05].Conclusion Penehyclidine hydrochloride injection controls the release of TNF-α,IL-6 and IL-8 of inflammatory cell factor,relieves pneumonia after CPB and shortens the mechanical airing time in CPU.%目的 观察长托宁对冠状动脉脉搭桥术(CABG)心肺转流(CPB)炎性细胞因子的影响.方法 39例接受CABG手术的患者完全随机分为长托宁1组、长托宁2组和对照组,各13例.长托宁1组和长托宁2组术前30 min肌内注射长托宁0.02～0.03 mg/kg；长托宁2组术后第24、48小时各静脉追加一次长托宁0.02～0.03 mg/kg；对照组术前30 min肌内注射阿托品0.01 mg/kg.观察3组患者注药前及注药30 min后体温及心率,分别于麻醉诱导前、CPB开始30 min、术后即刻、术后24、48 h采动脉血检测肿瘤坏死因子a(TNF-ct)、白细胞介素6(IL-6)和IL-8的浓度；观察术后胸部X线片肺炎发生率、呼吸机支持时间及ICU停留时间.结果 注药30 min后对照组患者的心率较注药前明显升高[(78.2±3.4) 次/min比(61.1±3.2)次/min;P＜0.05],且明显高于长托宁1组和长托宁2组同时间心率[分别为(56.7±1.4)、(58.9±5.3)次/min,均P＜0.05]；与麻醉诱导前相比,CPB后对照组炎性细胞因子的浓度均明显升高,CPB结束时达到最高值,术后缓慢下降,术后24、48 h均高于术前[TNF-a(12.2±2.1)ng/L比(19.4±1.7)ng/L、(26.3±2.5) ng/L、(19.1±1.7)ng/L、(16.3±1.3)ng/L,P＜0.05].组间比较,长托宁1组和长托宁2组最高值明显低于对照组(P＜0.05)；长托宁2组术后第24、48小时TNF-a、IL-6、IL-8值明显低于对照组,长托宁1组和长托宁2组术后呼吸机支持时间和ICU停留时间明显少于对照组[(10.6±3.7)h、(9.6±7.7)h,(11.8±7.7)h,(3.5±1.9)h、(3.0±1.8)h比(3.9±1.8)h,均P＜0.05].结论 CABG患者术前及术后应用长托宁能有效抑制炎症细胞因子TNF-a、IL-6、IL-8的释放,减轻CPB后的肺部炎症,缩短机械通气和ICU停留时间,比单纯术前应用长托宁效果更好.