摘要
目的 探究术前雾化吸入布地奈德对心脏瓣膜置换术后肺部感染和白细胞介素6/信号转导与转录激活因子3(IL-6/STAT3)炎症信号通路的影响。方法 采用前瞻、随机的病例对照实验,选择2019年1月-2020年12月医院拟接受心脏瓣膜置换术的患者101例为研究对象,随机分为研究组50例和对照组51例。两组均接受静脉注射氨溴索,研究组术前3 d雾化吸入布地奈德。比较两组患者术后心脏功能、肺功能及感染情况。结果 研究组术后肺部感染发生率6.0%(3/50)、住院时间(16.58±4.21)d均低于对照组(P<0.05)。术后24 h,两组心脏自动复跳率及心脏功能指标肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平比较,差异均无统计学意义;研究组血清炎性因子IL-6、STAT3、IL-1β、肿瘤坏死因子-α(TNF-α)水平均低于对照组(P<0.05);研究组术后pH值、氧分压(PaO)、肺活量及最大通气量均高于对照组,二氧化碳分压(PaCO)低于对照组(P<0.05)。结论 术前雾化吸入布地奈德可减少心脏瓣膜置换患者术后肺部感染的发生,同时降低IL-6/STAT3炎症信号通路水平,积极促进患者恢复。
OBJECTIVE To explore the effect of preoperative aerosol inhalation of budesonide on postoperative pulmonary infection and interleukin-6/signal transducer and activator of transcription 3(IL-6/STAT3) inflammation signaling pathway of patients undergoing heart valve replacement surgery. METHODS By means of prospective, randomized case-control experiment, a total of 101 patients who underwent heart valve replacement surgery in the hospital from Jan 2019 to Dec 2020 were recruited as the study subjects and randomly divided into the study group with 50 cases and the control group with 51 cases. Both groups received intravenous injection of ambroxol, and the study group was given aerosol inhalation of budesonide 3 days before the surgery. The postoperative cardiac function, lung function and incidence of infection were observed and compared between the two groups of patients. RESULTS The incidence rate of postoperative pulmonary infection of the study group was 6.0%(3/50), significantly lower than that of the control group, the length of hospital stay of the study group was(16.58±4.21)days, significantly shorter than that of the control group(P<0.05). There were no significant differences in the cardiac automatic re-beating rate and levels of cardiac function indexes creatine kinase(CK), creatine kinase isoenzyme(CK-MB), cardiac troponin I(cTn I) between the two groups of patients after the surgery for 24 hours. The levels of serum inflammatory factors IL-6, STAT3, IL-1β and tumor necrosis factor-α(TNF-α) of the study group were significantly lower than those of the control group(P<0.05). The pH value, partial pressure of oxygen(PaO), vital capacity and maximal voluntary ventilation of the study group were significantly greater than those of the control group after the surgery, while the partial pressure of carbon dioxide(PaCO) of the study group was significantly lower than that of the control group(P<0.05). CONCLUSION The preoperative aerosol inhalation of budesonide may reduce the incidence of postoperative pulmonary infection of the heart valve replacement patients, lower the levels of IL-6/STAT3 inflammatory signaling pathway, and facilitate the rehabilitation of the patients.
作者
丁付燕
孟树萍
王书鹏
朱佳璐
胡延磊
DING Fu-yan;MENG Shu-ping;WANG Shu-peng;ZHU Jia-lu;HU Yan-lei(Henan Provincial People's Hospital Heart Center,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第2期193-197,共5页
Chinese Journal of Nosocomiology
基金
河南省卫生健康委员会基金资助项目(LHGJ20200093)。
关键词
心脏瓣膜置换术
术后肺部感染
布地奈德雾化吸入
IL-6/STAT3炎症信号通路
Cardiac valve replacement surgery
Postoperative pulmonary infection
Aerosol inhalation of budesonide
IL-6/STAT3 inflammatory signaling pathway
作者简介
通讯作者:胡延磊,huyanlei352@163.com;丁付燕(1984-),男,硕士研究生,主治医师,研究方向:心脏大血管外科围术期管理。
