摘要
目的探讨前列地尔对止血带诱发的肺换气功能损伤的保护作用。方法选择择期行单侧膝关节置换术患者30例,入室后随机分为对照组(A组)和观察组(B组),常规监测心电图、血氧饱和度、无创血压及心率。二组均患侧卧位,行腰硬联合阻滞麻醉。上止血带前15min B组缓慢滴入前列地尔5μg,二组下肢驱血后气压止血带加压50KPa,手术结束前20min停止吸氧,手术结束松止血带后B组立即缓慢滴入凯时(前列地尔)5μg,整个手术过程静脉输入生理盐水,术毕生命体征平稳送回病房。分别在以下几个时间点采集动脉血和静脉血:麻醉翻身后面罩吸氧前(T1)、松止血带后10min(T2)、松止血带后1h(T3)、松止血带后3h(T4),动脉血用于血气分析,静脉血立即冷冻保存于-70℃冰箱待测,静脉血采用酶联免疫吸附法(ELISA)测定丙二醛(MDA)和人肺泡表面活性特异蛋白D(SP-D);对以上时间点肺功能进行评估:氧分压(PaO2)及二氧化碳分压(PaCO2),肺泡动脉氧分压差(PaA-a DO2),呼吸指数(RI)。结果 A组T3时刻PaO2值较T1明显下降,比较差异有统计学意义(P<0.05);T3、T4时刻PaA-a DO2、RI值较T1明显升高,比较差异有统计学意义(P<0.05);B组T3时刻PaA-a DO2和RI值较T1明显升高,比较差异有统计学意义(P<0.05)。A、B二组T3时刻PaO2组间比较差异有统计学意义,B组高于A组(P<0.05);PaA-a DO2及RI值在T3、T4时刻比较差异有统计学意义,A组高于B组(P<0.05)。MDA及SP-D值在松止血带后值都出现升高,A组MDA在T3、T4时刻较T1明显升高,差异有统计学意义(P<0.05);SP-D在T3、T4时刻较T1明显升高,差异有统计学意义(P<0.05)。B组SP-D在T3、T4时刻较T1明显升高,差异有统计学意义(P<0.05)。A、B二组T3、T4时刻MDA及SP-D组间比较差异有统计学意义,A组高于B组(P<0.05)。结论前列地尔一定程度上可以抑制缺血再灌注所引起的肺损伤,对止血带诱发的肺换气功能损伤起到保护作用。
Objective To investigate the protective effect of alprostadil on pulmonary ventilation injury in- duced by tourniquet. Methods Totally 30 patients who undenwent total knee replacement operations were randomly divided into two groups： experimental group （group A） and control group（group B）, 15 patients in each group respectively. ECG, HR, non- invasive blood pressure and SpO2 were monitored during an- esthesia. In group B, 5μg alprostadil were given fro^m vein 15 rain before tourniquet inflation and deflation after surgery. In group A, equal volume of normal saline was, infused at the same time points. Blood sam- ples were taken from vein and artery at the following time points： before mask oxygenation（T1）, 10 rain after tourniquet deflation（T2）, lh after tournique deflation（T3） - 3h after tourniquet def.lation （T4）. The arterial blood samples were used for blood gas analysis, Paa-aDO2 and respiratory index（RI） were calculat- ed. The plasma MDA and SP- D were determined of vein blood by ELISA. Results In group A, PaOz was low- er at T3 than it at T1, PaA-aDO2 and RI were higher at T3 and T4 than those at T1, they had significant differ- ence（P〈0. 05）. In group B, PaA-aDO2 and R1 were higher at T3 than those at T1, they had significant differ- enee（P〈0.05）. PaO2 was higher in group B than it in group A at T3, （P〈0. 05） ;PaA-aDO2 and RI were higher in group A than those in group B at T3 and T4 （P〈0.05）. After deflation tourniquet, MDA and SP - D were increase in both groups, MDA were higher at T3 and T4 than it at T1 in group A（P〈0.05） ;SP- D was higher at T3 and T4 than it at TI（P%0. 05）. In group B, SP- D was higher at T3 and T4 than it at T1 （F〈0.05）.MDA and SP- D were higher in group A than those in group B at T3 and T4 （P〈0. 05）. Conclusion A1- prostadil can anenuate the damage to lung of ischemical reperfusion by tourniquet at a certain extent,it can defend the function of pulmonary ventilation after deflation tourniquet.
出处
《中国煤炭工业医学杂志》
2013年第9期1434-1437,共4页
Chinese Journal of Coal Industry Medicine
关键词
前列地尔
缺血再灌注
肺损伤
Alprostadil
Ischemia- reperfusion
Injury of lung
作者简介
通讯作者
