Ng Calvin S H, Arifi Ahmed A, Wan Song, Ho Anthony M H, Wan Innes Y P, Wong Eric M C, Yim Anthony P C
Department of Cardiothoracic Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
Ann Thorac Surg. 2008 Jan;85(1):154-62. doi: 10.1016/j.athoracsur.2007.07.068.
A complex inflammatory response associated with the use of cardiopulmonary bypass may ultimately lead to organ dysfunction. We investigate the effect of continuing ventilation during cardiopulmonary bypass on inflammatory reactions and cardiopulmonary function.
Fifty patients undergoing cardiopulmonary bypass were prospectively randomized to continuous ventilation and nonventilation groups. Plasma interleukin-8, interleukin-10, matrix metalloproteinase-9, tissue inhibitor metalloproteinase-1, and thromboxane B2 levels were measured preoperatively, at 1, 4, and 6 hours after aortic declamping. Levels of these mediators were also determined in bronchoalveolar lavage preoperatively and four hours after declamping. Seven parameters of cardiopulmonary function, including dynamic compliance and systemic vascular resistance, were recorded during the same time points.
Plasma interleukin-10 levels were higher at 6 hours and tissue inhibitor metalloproteinase-1 levels were higher at 1 hour after aortic declamping in the continuous ventilation compared with the nonventilation group (p = 0.04 and 0.002, respectively), while bronchoalveolar lavage levels of tissue inhibitor metalloproteinase-1 were also higher in the continuous ventilation group 4 hours after declamping (p = 0.02). Plasma interleukin-8 levels were higher at 4 hours after declamping in the nonventilation group (p = 0.04). Postoperative dynamic compliance was better preserved in continuous ventilation patients than nonventilation patients at 6 hours after declamping (p = 0.0008).
Continued ventilation during cardiopulmonary bypass results in lesser inflammatory and proteolytic responses, and may better preserve pulmonary function than cardiopulmonary bypass without ventilation.
与体外循环使用相关的复杂炎症反应最终可能导致器官功能障碍。我们研究体外循环期间持续通气对炎症反应和心肺功能的影响。
五十例行体外循环的患者被前瞻性随机分为持续通气组和非通气组。在术前、主动脉钳夹松开后1小时、4小时和6小时测量血浆白细胞介素-8、白细胞介素-10、基质金属蛋白酶-9、金属蛋白酶组织抑制剂-1和血栓素B2水平。术前及钳夹松开后4小时还测定支气管肺泡灌洗中这些介质的水平。在相同时间点记录包括动态顺应性和体循环血管阻力在内的七个心肺功能参数。
与非通气组相比，持续通气组在主动脉钳夹松开后6小时血浆白细胞介素-10水平较高，1小时时金属蛋白酶组织抑制剂-1水平较高（分别为p = 0.04和0.002），而连续通气组在钳夹松开后4小时支气管肺泡灌洗中金属蛋白酶组织抑制剂-1水平也较高（p = 0.02）。非通气组在钳夹松开后4小时血浆白细胞介素-8水平较高（p = 0.04）。在钳夹松开后6小时，持续通气患者的术后动态顺应性比非通气患者保存得更好（p = 0.0008）。
体外循环期间持续通气导致炎症和蛋白水解反应较轻，并且与非通气的体外循环相比可能更好地保存肺功能。
