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1、異丙酚對體外循環(huán)患者肺保護(hù)作用臨床探究［摘要］目的：通過觀察異丙酚對體外循環(huán)(CPB)患者中性粒細(xì)胞(PMN)核因子kB(NFkB)活性和肺順應(yīng)性的影響，探討異丙酚肺保護(hù)作用機(jī)制。方法：將30例行CPB心瓣膜置換術(shù)病例隨機(jī)分成D組(CPB期間異丙酚麻醉維持組)和M組(咪哩安定麻醉維持組)，每組15例。分別于麻醉前、CPB開始后30min、CPB停止后30min、4h、24h抽取橈動脈血3ml,運(yùn)用電泳遷移率實(shí)驗(yàn)檢測NFkB活性，使用Datex多功能氣體監(jiān)測儀，觀察并記錄患者CPB前、停機(jī)即刻、術(shù)畢氣道壓力及肺順應(yīng)性變化。分別采用
2、配對和非配對t檢驗(yàn)進(jìn)行組內(nèi)、組間差異的統(tǒng)計(jì)學(xué)分析，比較兩組間PMNNFkB活性和氣道壓力、肺順應(yīng)性變化。結(jié)果：兩組患者PMNNFkB活性在CPB停止后30min達(dá)到峰值，觀察組在CPB開始后30min、CPB停止后30min、4h、24hPMNNFkB活性低于對照組。CPB停機(jī)即刻，兩組患者氣道順應(yīng)性明顯降低，D組患者明顯高于M組(P<；0.05)；術(shù)畢P組患者氣道順應(yīng)性高于M組(P<；0.05),且與CPB前相比差異無顯著性(P>；0.05)o結(jié)論：異丙酚可以減低CPB患者PMNNFkB活性，對CPB期間肺損傷具有
3、一定保護(hù)作用。［關(guān)鍵詞］異丙酚；心肺轉(zhuǎn)流術(shù)；核因子KB；肺保護(hù)ProtectionofPropofolonPulmonaryFunctioninPatientsUndergoingCardiopulmonaryBypassAbstract:ObjectiveTostudytheeffectsofpropofolontheNFkBactivityandpulmonarycomplianceandexploremechanismofitspulmonaryprotection.MethodsThirtyASAIIIIIpatient
4、sundergoingcardiacvalvereplacementsurgerywithCPBwererandomlydividedintotwogroups.AnesthesiawasmaintainedwithpropfolingroupPandwithmidazolamingroupM.3milliliterradialarterybloodwasabstractedbeforeinduetionofanesthesia,30minafterCPB,30min,4hoursand24hoursafterCPBfinish
5、ing.NFkBactivitywastestedinelectrophoreticmobilityshiftassay(EMSA).ThevarietyofpulmonarycomplianceandpeakpressureofairwaybeforeCPB,attheendofCPBandsurgerywasmonitoredandrecorded.ThedifferencesbetweenthetwogroupswereanalyzedwithStudentttest?ResultsThepeakvalueofNFkBac
6、tivitywasgot30minafterCPBinbothgroup.TheNFkBactivityingroupPwaslowerthanthatingroupD30minafterCPB,30min,4hoursand24hoursafterCPBfinishing.PulmonarycompliancedecreasedsignificantlyinbothgroupsattheendofCPB,butitwasbetteringroupPthanthatingroupMattheendofCPBorattheendo
7、fsurgery(P&It；0.05).ConclusionPropfolcanreducetheactivityofNKkBandplaysaroleonpulmonaryprotectionduringCPB.Keywords：Propofol；Cardiopu1monarybypass；NFkB；Pulmonaryprotection心肺轉(zhuǎn)流術(shù)(CardiopulmonaryBypass,CPB)可觸發(fā)一系列全身急性炎癥反應(yīng)(SIR),核因子kB(NuclearFactorkB,NFkB),是多種細(xì)胞因子和炎癥介質(zhì)的基因轉(zhuǎn)
8、錄和級聯(lián)放大過程的共同通路和作用位點(diǎn)，該基因序列的活化可加重CPB及心臟缺血再灌注損傷中的炎癥反應(yīng)程度[l]o近年來的研究表明，異丙酚可以通過影響PMN的效應(yīng)作用、促/抗炎細(xì)胞因子水平、氧自由基和一氧化氮的產(chǎn)生等炎性反應(yīng)多個(gè)環(huán)節(jié)來防止過度失控的全身炎性反應(yīng)的發(fā)生
