Objective To compare the parameter changes of organ damage, inflammation, and oxidative stress in patients undergoing open-heart surgery during cardiopulmonary bypass with oxygen tension controlled at 60 and 170 mmHg.Methods Eighty patients undergoing open-heart surgery were randomly divided into the low oxygen tension group and high oxygen tension group with 40 patients in each.The oxygen tension in the low oxygen tension group and high oxygen tension group was 60 mmHg and 170 mmHg, respectively.The plasma was collected before surgery and at 30 min, 2 h, 6 h, 24 h after aortic declamping (T0-T4).The levels of glutamic-pyruvic transaminase (ALT), glutamic oxalacetic transaminase (AST), alkaline phosphatase (ALP), creatinine (Cr), urea nitrogen (UN), uric acid (UA) in the plasma were measured by fully automatic biochemical analyser;the levels of cardiac troponin (cTnI), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) in the plasma were measured by ELISA;reactive oxygen (ROS), malonaldehyde (MDA) in the plasma were measured by kits.Results The levels of cTnI, CK-MB, ALT, AST, ALP, Cr, UN, and UA in the plasma of both groups increased significantly at T1-T4 as compared with those of the same group at T0 (all P<0.05);compared with the high oxygen tension group, the levels of cTnI, CK-MB, AST, ALT, ALP, Cr, UN, and UA in the low oxygen tension group at T2-T4 decreased significantly (all P<0.05).The levels of CRP, TNF-α and IL-6 increased significantly at T1-T4 as compared with those of the same group at T0 (all P<0.05);compared with the high oxygen tension group, the levels of CRP, TNF-α and IL-6 in the low oxygen tension group at T1-T4 decreased significantly (all P<0.05).The levels of ROS and MDA in both groups at T1-T4 increased significantly as compared with those of the same group at T0 (all P<0.05);compared with the high oxygen tension group, the levels of ROS and MDA in the low oxygen tension group at T1-T4 decreased significantly (all P<0.05).Conclusion Compared with the high oxygen tension, using low oxygen tension during CPB in open-heart surgery can reduce CPB-induced organ damage, inflammation, and oxidative stress significantly.%目的 比较体外循环(CPB)期间血氧分压控制在60、170 mmHg的心内直视手术患者心肝肾损伤指标、炎症因子、氧化应激指标变化.方法 80例择期行心内直视手术患者随机分为低氧组和高氧组各40例,低氧组、高氧组在CPB期间血氧分压分别控制在60、170 mmHg.分别于术前及开主动脉后30 min、2 h、6 h、24 h(T0~T4)抽取患者静脉血,采用全自动生化分析仪检测血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、肌酐(Cr)、尿素氮(UN)、尿酸(UA),ELISA法检测血清心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α),采用试剂盒检测血清活性氧(ROS)、丙二醛(MDA).结果 与同组T0时点比较,两组T1~T4时点cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平升高(P均<0.05);与高氧组比较,低氧组T2~T4时点cTnI、CK-MB、AST、ALT、ALP、Cr、UN、UA水平降低(P均<0.05).与同组T0时点比较,两组T1~T4时点CRP、TNF-α、IL-6水平升高(P均<0.05);与高氧组比较,低氧组T1~T4时点CRP、TNF-α、IL-6水平降低(P均<0.05).与同组T0时点比较,两组T1~T4时点ROS、MDA水平升高(P均<0.05);与高氧组比较,低氧组T1~T4时点ROS、MDA水平降低(P均<0.05).结论 相对于高血氧分压,心内直视手术患者CPB期间采用低血氧分压能够显著降低由CPB引发的心肝肾损伤、炎症反应及氧化应激.
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