国际麻醉学与复苏杂志   2019, Issue (8): 0-0
    
术前应用重组人促红素对体外循环后炎性肺损伤的影响
林雪, 马晓贝, 高伟, 张瑞芹, 潘红, 崔晓光1()
1.哈尔滨医科大学附属第二医院
Effect of preoperative recombinant human erythropoietin administration on inflammatory lung injury due to cardiopulmonary bypass
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摘要:

目的 探讨术前应用重组人促红素(recombinant human erythropoietin, rHuEPO) 对心脏直视手术患者CPB所致炎性肺损伤的影响。 方法 选择择期心脏直视手术需CPB的患者54例,按随机数字表法分为2组(rHuEPO组和对照组),每组27例。 rHuEPO组术前连续3 d同一时段静脉滴注rHuEPO(100 U/kg,生理盐水稀释到50 ml),对照组在相同时间点静脉滴注等量生理盐水。监测并记录患者行CPB前(T1)、关胸后(T2)、术后2 h(T3)、术后 4 h (T4)、术后6 h(T5)的气道峰压(peak airway pressure, Ppeak)、平台压(plateau pressure, Pplat)和肺动态顺应性(pulmonary dynamic compliance, Cdyn),同时在T1、T2、T5、术后12 h(T6)、术后24 h(T7)、术后48 h(T8)、术后72 h(T9)7个时间点采集外周动脉血行血气分析,记录氧合指数(oxygenation indices, OI)。分别于rHuEPO给药前(T0)、T1、T2、T5、T6、T7、T8和T9 8个时间点,检测血清TNF-α、IL-1β和IL-10水平。记录患者术毕入ICU后机械通气时间、停留时间,从术毕至出院时间及总住院时间。 结果 与对照组比较,rHuEPO组T2~T5时点Cdyn均升高(P<0.05),而Ppeak和Pplat均降低(P<0.05)。T2及T5~T9时点,rHuEPO组OI明显高于对照组(P<0.05)。关胸后各时点,rHuEPO组和对照组TNF-α、IL-1β、IL-10水平较关胸前均升高,但TNF-α和IL-1β水平rHuEPO组低于对照组(P<0.05)。与对照组比较,rHuEPO组入ICU后机械通气时间和停留时间均少于对照组(P<0.05);rHuEPO组的术毕至出院时间以及总住院时间均短于对照组,但差异无统计学意义(P>0.05)。 结论 术前给予rHuEPO可能通过抑制炎症反应减轻CPB所致肺损伤,改善肺功能。

关键词: 重组人促红素; 体外循环; 肺损伤; 炎症反应
Abstract:

Objective To discuss the effects of preoperative use of recombinant human erythropoietin (rHuEPO) on inflammatory lung injury patients after cardiopulmonary bypass (CPB) under extracorporeal circulation.  Methods A total of 54 patients who were scheduled to receive elective open cardiac operations under CPB were enrolled. They were divided into two groups(n=27). rHuEPO group: patients were titrated intravenously with rHuEPO (100 IU/kg, diluted into 50 ml normal saline) for consecutive three days at the same time period before operation. Control group: equivalent normal saline in place of rHuEPO was given to patients via venous injection. Peak airway pressure (Ppeak), plateau pressure (Pplat), and pulmonary dynamic compliance (Cdyn) were well monitored and recorded before CPB (T1), immediately after chest closure (T2), and 2, 4 h and 6 h after surgery (T3, T4, and T5). At T1, T2, T5, and 12, 24, 48 h, and 72 h after surgery (T6, T7, T8, and T9), arterial oxygenation indices (OI) were also recorded. Furthermore, at pre-rHuEPO treatment (T0), T1, T2, T5, T6, T7, T8, and T9, the plasma levels of the tumor necrosis factor (TNF)-α and interleukin (IL)-1β and IL-10 were measured. The time of mechanical ventilation and stay in intense care unit (ICU), discharge time and hospitalization stay were also recorded. Results Compared with the control group, Cdyn in the rHuEPO group at T2-T5 were significantly increased (P<0.05), whereas Ppeak and Pplat were decreased (P<0.05). OI values of rHuEPO group at T2 and T5-T9 were significantly higher than that of control group(P<0.05). It was demonstrated that at any time point after closing chest, the plasma concentrations of TNF-α, IL-1β, and IL-10 in both groups were relatively elevated compared with those before, while the concentrations of TNF-α and IL-1β in the rHuEPO group were lower than those in control group (P<0.05). Compared with the control group, patients receiving rHuEPO treatment underwent an apparent reduction in both mechanical ventilation and staying time in ICU (P<0.05).  Conclusions Preoperative rHuEPO administration can attenuate the inflammatory lung injury after CPB via the anti-inflammation pathway and ameliorate pulmonary functions.

Key words: Recombinant human erythropoietin; Cardiopulmonary bypass; Lung injury; Inflammatory response