肢体远隔缺血预处理对胸腔镜体外循环心脏手术的肺保护作用

摘要

目的:探讨肢体远隔缺血预处理对胸腔镜体外循环心脏手术的肺保护作用及其机制.方法:胸腔镜体外循环心脏手术患者81 例,ASAⅡ～Ⅲ级,随机分为试验组(给予肢体远隔缺血预处理,n ＝ 41)和对照组(不给予肢体远隔缺血预处理,n ＝ 40).采集患者术中及术后临床指标,分别在手术开始前、手术结束后6、24 h 采集桡动脉血检测氧合指数(PaO2/FiO2)、血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及丙二醛(MDA)水平.结果:两组患者术后机械通气时间试验组小于对照组,组内比较术后6、24 h 血浆TNF-α、IL-6、MDA 水平明显高于手术开始时的水平,术后6、24 h PaO2/FiO2 明显低于手术开始时的水平;但是组间比较术后6、24 h 血浆TNF-α、IL-6、MDA 水平试验组低于对照组,术后6、24 h PaO2/FiO2 试验组高于对照组,差异有统计学意义(P ＜ 0.05).结论:肢体远隔缺血预处理对胸腔镜体外循环心脏手术中肺损伤具有一定的保护作用,是一种简单、有效的肺保护方法.%Objective To investigate the effect and mechanism of limb remote ischemic preconditioning on pulmonary protection in thoracoscopic cardiac surgery with cardiopulmonary bypass (CPB). Methods Eighty-one patients undergoing thoracoscopic cardiac surgery with CPB , and ASA Ⅱ~Ⅲ , were randomized into experimental group (with limb remote ischemic preconditioning, n = 41) and control group (without limb remote ischemic preconditioning, n = 40). The intra- and post-operative clinical data were gathered. The blood samples from radial artery were collected for oxygenation index (PaO2/FiO2) , tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and malondialdehyde (MDA) analysis at the beginning, 6 h and 24 h after the end of surgery. Results The postoperative mechanical ventilation time of experimental group was shorter than that of control group. According to within-group comparisons , the plasm TNF-α , IL-6 and MDA levels at 6 h and 24 h after the end of surgery were higher than that at the beginning of the surgery. However, the plasm TNF-α, IL-6 and MDA levels at 6 h and 24 h after surgery in experimental group were lower than those in the control group , and the oxygenation indexs at 6 h and 24 h after surgery in experimental group were higher than those in the control group (P < 0.05). Conclusion The limb remote ischemic preconditioning, as a simple and effective pulmonary protection method , showed obvious pulmonary protective effect in thoracoscopic cardiac surgery with CPB.