国际麻醉学与复苏杂志   2020, Issue (4): 7-7
    
急性A型主动脉夹层患者围手术期血浆P‑选择素 水平与急性肺损伤的关系探讨
魏海燕, 史宏伟, 李滢, 施婕 , 葛亚力, 施韬, 鲍红光1()
1.南京医科大学附属南京医院（南京市第一医院）
Relationship between plasma P‑selectin level and acute lung injury in patients with acute type A aortic dissection during the perioperative period
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摘要：

目的 探讨急性A型主动脉夹层（acute type A aortic dissection, ATAAD）患者围手术期血浆P‑选择素水平与急性肺损伤（acute lung injury, ALI）的关系。 方法 ATAAD患者46例，根据围手术期ALI诊断标准分为两组：术前ALI组（A组，24例）和术前非ALI组（NA组，22例）。所有患者均在全身麻醉和深低温停循环（deep hypothermic circulatory arrest, DHCA）下行孙氏手术（主动脉弓人工血管替换和象鼻支架植入术）。分别于麻醉诱导前（T0）、手术结束时（T1）和术后12 h（T2）抽取动脉血行血气分析，计算氧合指数（oxygenation index, OI），并同时抽取静脉血检测血浆P‑选择素水平、血小板计数（platelet count, PC）、平均血小板体积（mean platelet volume, MPV）、血小板分布宽度（platelet distribution width, PDW）。 结果 A组患者各时点OI低于NA组（P<0.05）；与T0比较，A组患者T1时OI降低、T2时增高，NA组患者T1、T2时OI均降低（P<0.05）。A组患者各时点血浆P‑选择素水平高于NA组（P<0.05），T0时PC低于NA组（P<0.05）。与T0比较，两组患者T1时血浆P‑选择素水平、PDW增高，PC、MPV降低（P<0.05）；T2时血浆P‑选择素水平增高，PC降低（P<0.05）。血浆P‑选择素水平与OI呈负相关（r=−0.793，P<0.05）。 结论 ATAAD患者围手术期多种因素导致血小板活化、血浆P‑选择素水平增高，是围手术期发生ALI的重要因素。围手术期采取措施减少血小板活化、降低血浆P‑选择素水平可能有助于ALI的防治。
关键词： 主动脉夹层； P‑选择素； 急性肺损伤； 氧合指数； 血小板
Abstract:

Objective To investigate the relationship between plasma P‑selectin level and acute lung injury (ALI) in patients with acute type A aortic dissection (ATAAD) during the perioperative period. Methods Forty‑six ATAAD patients were enrolled. According to the perioperative diagnostic criteria of ALI, the patients were divided into two groups: a preoperative ALI group (group A, n=24) and a preoperative non‑ALI group (group NA, n=22). All the patients underwent total aortic arch replacement combined with stented elephant trunk implantation (the Sun's procedure) under general anesthesia and deep hypothermic circulatory arrest (DHCA). Arterial blood was collected before anesthesia induction (T0), at the end of operation (T1) and 12 h after operation (T2) for blood gas analysis, and oxygenation index (OI) was calculated. At the same time, venous blood was taken to detect plasma P‑selectin level, platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW). Results Patients in group A presented a lower OI than those in group NA at each time point (P<0.05). Compared with those at T0, OI decreased at T1 but increased at T2 for patients in group A, while OI decreased at T1 and T2 for patients in group NA (P<0.05). Compared with those in group NA, patients in group A produced an increased level of plasma P‑selectin at each time point (P<0.05), and a decreased PC at T0 (P<0.05). Compared with those at T0, both groups produced increased levels of plasma P‑selectin and PDW as well as decreased PC and MPV at T1 (P<0.05); and increased levels of plasma P‑selectin and decreased PC at T2 (P<0.05). There was a negative correlation between plasma P‑selectin level and OI (r=−0.793, P<0.05). Conclusions Many factors lead to platelet activation and an increased level of plasma P-selectin in ATAAD patients during the perioperative period, which is an important factor for ALI during the perioperative period. Perioperative measures to weaken platelet activation and reduce plasma P‑selectin level may contribute to prevention and treatment of ALI.
Key words: Dissection of aortic; P‑selectin; Acute lung injury; Oxygenation index; Platelet