不同机械通气方式对冠状动脉旁路移植术后机体炎症介质浓度的影响

摘要

Objective Not only the systemic inflammation and acute organ injury are all caused by inflammatory mediators but also the intension of them are close relate the levds of inflammatory mediators.Through observation on the content of Interleukin 6 Interloakin 8 in two diffenmt medmenl ventilation groups(high tidal volunles/low positive end-expiratory pressure,low tidal Volunes/ high positive end-expiratory pressure)to find which is the better ventilatory method to the patients undergoing coronary artery bypass grafting.Methods Forty patients undergoing elective coronary artery bypass were randomized to be ventilated after cardiaopulmonary bypass disconnection with high tidal volumes/low poaitive end-expirstory pressure(10-12 ml/kg and 2-4 emH2O) or low tidal vol-umes/high positive end-expiratory pressure(6-8 ml/kg and 8-10 cmH2O).Intedeukin 6 and Intedeukin 8 levels were measured in the bronchoalveolar lavage fluid and plasma.Samples were taken before sternotmy(TO),immeditately after cardiaopulmonary bypass seperation(T1),and after 6 hours of medlmieal ventilation(T2).Results Interleukin 6 and Intedeukin 8 levels in the bronchoalveo-lariavagefluid and plm aignitleamlyincreased atTI in both groups but further increased signiiieantly at T2 onlyin patients ventilat-ed with tidal volumes/low positive end-expiratory pressure.Conclusion Ventilation with low tidal volumes/high positive erd-ex-piratory pressure not increased the level of inflammatory mediators,mediators,protects the systemic function to patients,avoids acute organ inju-ry,is the better ventilatory method for patients undergoing cotonary artery bypass grafting from cardiaopulmonary bypass.%目的 观察大潮气量低呼吸终末压力(H.Vt/L-PEEP)和低潮气量高呼吸终末压力(LwH_PEEP)两种不同机械通气方式对冠状动脉旁路移植术后机体炎症介质IL--6和IL-8浓度的影响,寻找冠状动脉旁路移植术后更为合理的机械通气方式.方法 40例择期行冠状动脉旁路移植术者在相同的麻醉和体外循环条件下,按大潮气量低呼吸终末压力和低潮气量高呼吸终末压力机械通气方式随机分为两组,分别于开胸前(TO)、体外循环结束(T1)、体外循环停止机械通气6 h(r12)采集支气管灌洗液和中心静脉血样本,观察3个时点两组Ⅱ,6及IL-8在支气管灌洗液和血浆中的浓度变化.结果 两组支气管灌洗液及血浆炎症介质IL-6、IL-8浓度在Tl时显著增高.机械通气6 h后(12)L-VdH.PEEP组支气管灌洗液及血浆Ⅱ,6、IL-8浓度无明显改变,而H-VdL-PEEP组则显著升高(P