摘要
目的通过观察心肺转流(CPB)中控制动脉氧分压(PaO2)对心脏瓣膜置换术患者红细胞免疫功能及脂质过氧化损伤的影响,探讨其对红细胞的保护作用。方法选择20例择期行心脏瓣膜置换术患者,随机均分为两组,控制PaO2组(Ⅰ组,PaO2100～250mmHg)和高PaO2组(Ⅱ组,PaO2350～450mmHg)。入手术室后行桡动脉、中心静脉穿刺,气管插管全身麻醉后建立CPB,CPB后通过调节吸入氧浓度调节控制PaO2。两组均在麻醉前(T1)、CPB前(T2)、CPB后15min(T3)、主动脉开放15min(T4)、术后24h(T5)抽动脉血分别作酵母菌花环试验、检测红细胞内丙二醛(MDA)含量,血浆游离血红蛋白(PF-Hb)及血浆MDA含量。结果与T1时比较,T3～T5时两组RBC-C3bRR明显降低、RBC-ICRR明显升高(P<0.05);T2～T5时两组PF-Hb明显升高(P<0.05)。与Ⅰ组比较,T4、T5时Ⅱ组RBC-ICRR明显降低(P<0.05);T3～T5时Ⅱ组PF-Hb、红细胞MAD含量和T3、T4时血浆内MAD含量明显升高(P<0.05)。结论 CPB可导致损伤及免疫功能下降,CPB中控制PaO2可减轻红细胞的脂质过氧化损伤,减轻对红细胞的免疫功能的损伤,对CPB中的红细胞有较好的保护作用。
Objective To explore the protective effect on RBC by investigating the contribution on erythrocyte immune function and lipid peroxidation injuries in patients with heart valve replacement by controlling the oxygen partial pressure during cardiopulrnonary bypass. Methods Twenty patients underwent heart valve replace-ment were randomly allocated into two groups, group I maintained PaO2 100-250 mm Hg during cardiopulmonary bypass and group II maintained PaO2 350-450 mm Hg. CPB were established after radial artery and central venous puncture and tracheal intubation. Arterial oxygen partial pressure was controlled according to FiO2. Arterial blood were drawn at the time before anesthesia（T1 ）, before CPB（T2）, CPB for 15 min（T3 ）, 15 min after aortic unclamping （T4） and 24 h after operation （T5）. RBC-C3bRR and RBC-ICRR were counted, content of PF-Hb, MDA in plasma and RBC were detected. Results Comparison with T1, T3-T5 two group RBC-C3bRR significantly decreased, RBC-ICRR increased significantly （P 〈 0.05） ; T2- T5 PF-Hb increased significantly （P〈0.05）. Compared with group [ , T4, Ts 1I RBC-ICRR were significantly decreased （P〈0.05）; T3-Ts II PF-Hb, red cells MAD content and T3, T4 plasma significantly increased the content of MAD （P〈0. 05）. Conclusion CPB leads to RBC injury and a decline in erythrocyte immune function. Arterial oxygen partial pressure controlling during CPB can decrease lipid peroxidation and immune function injuries of RBC, and show a protective effect on RBC.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第10期975-977,共3页
Journal of Clinical Anesthesiology
基金
贵州省科学技术基金资助(黔科合丁[2006]2072号)
