CPB期间血氧分压在60和170 mmHg的心内直视 手术患者心肝肾损伤、炎症、氧化应激指标观察

Objective To compare the parameter changes of organ damage, inflammation, and oxidative stress in patients undergoing open-heart surgery during cardiopulmonary bypass with oxygen tension controlled at 60 and 170 mmllg. Methods Eighty patients undergoing open-heart surgery were randomly divided into the low oxygen tension group and high oxygen tension group with 40 patients in each. The oxygen tension in the low oxygen tension group and high oxygen tension group was 60 mmllg and 170 mmllg, respeetively. The plasma was collected before surgery and at 30 min, 2 h, 6 h, 24 h after aortic declamping (T0-T4). The levels of glutamic-pyruvic transaminase (ALT), glutamie oxalacetic transaminase (AST), alkaline phosphatase (ALP), creatinine (Cr) , urea nitrogen (UN) , uric acid ( UA) in the plasma were measured by fully automatic biochemical analyser; the levels of eardiae troponin (cTnl) , ereatine kinase isoenzyme (CK-MB) , C-reaetive protein (GRP), interleukin 6 (IL-6) , tumor necrosis factor-α (TNF-α) in the plasma were measured by ELISA; reaetive oxygen ( ROS) , malonaldehyde ( MDA) in the plasma were measured by kits. Results The levels of cT-nl, CK-MB, ALT, AST, ALP, Cr, UN, and UA in the plasma of both groups increased significantly at T1-T4 as compared with those of the same group at T0(all P<0.05) ; compared with the high oxygen tension group, the levels of cTnl, CK-MB, AST, ALT, ALP, Cr, UN, and UA in the low oxygen tension group at T2-T4 decreased significantly (all P <0.05). The levels of CRP, TNF-α and IL-6 increased significantly at T,-T4 as compared with those of the same group at T0(all P <0.05) ; compared with the high oxygen tension group, the levels of CRP, TNF-α and IL-6 in the low oxygen tension group at T1-T4 decreased significantly (all P < 0.05 ). The levels of ROS and MDA in both groups at T1-T4 increased significantly as compared with those of the same group at T0 (all P <0.05 ) ; compared with the high oxygen tension group, the levels of ROS and MDA in the low oxygen tension group at T1-T4 decreased significantly (all P <0.05 ). Conclusion Compared with the high oxygen tension, using low oxygen tension during CPB in open-heart surgery can reduce CPB-in-duced organ damage, inflammation, and oxidative stress significantly. [ABSTRACT FROM AUTHOR]

目的　比较体外循环（ＣＰＢ）期间血氧分压控制在６０、１７０ ｍｍＨｇ 的心内直视手术患者心肝肾损伤指标、 炎症因子、氧化应激指标变化。方法　８０ 例择期行心内直视手术患者随机分为低氧组和高氧组各４０ 例，低氧组、 高氧组在ＣＰＢ 期间血氧分压分别控制在６０、１７０ ｍｍＨｇ。分别于术前及开主动脉后３０ ｍｉｎ、２ ｈ、６ ｈ、２４ ｈ（T0 ～ T4 ） 抽取患者静脉血，采用全自动生化分析仪检测血清谷草转氨酶（ＡＳＴ）、谷丙转氨酶（ＡＬＴ）、碱性磷酸酶（ＡＬＰ）、肌酐 （Ｃｒ）、尿素氮（ＵＮ）、尿酸（ＵＡ），ＥＬＩＳＡ 法检测血清心肌肌钙蛋白（ｃＴｎＩ）、肌酸激酶同工酶（ＣＫ-ＭＢ）、Ｃ 反应蛋白 （ＣＲＰ）、白细胞介素６（ＩＬ-６）、肿瘤坏死因子α（ＴＮＦ-α），采用试剂盒检测血清活性氧（ＲＯＳ）、丙二醛（ＭＤＡ）。结果 　与同组T0 时点比较，两组T1 ～ T4 时点ｃＴｎＩ、ＣＫ-ＭＢ、ＡＳＴ、ＡＬＴ、ＡＬＰ、Ｃｒ、ＵＮ、ＵＡ 水平升高（Ｐ 均＜ ０． ０５）；与高氧 组比较，低氧组T2 ～ T4 时点ｃＴｎＩ、ＣＫ-ＭＢ、ＡＳＴ、ＡＬＴ、ＡＬＰ、Ｃｒ、ＵＮ、ＵＡ 水平降低（Ｐ 均＜ ０． ０５）。与同组T0 时点比 较，两组T1 ～ T4 时点ＣＲＰ、ＴＮＦ-α、ＩＬ-６ 水平升高（Ｐ 均＜ ０． ０５）；与高氧组比较，低氧组T1 ～ T4 时点ＣＲＰ、ＴＮＦ-α、 ＩＬ-６水平降低（Ｐ 均＜０． ０５）。与同组T0 时点比较，两组T1 ～ T4 时点ＲＯＳ、ＭＤＡ 水平升高（Ｐ 均＜ ０． ０５）；与高氧组 比较，低氧组T1 ～ T4 时点ＲＯＳ、ＭＤＡ 水平降低（Ｐ 均＜０． ０５）。结论　相对于高血氧分压，心内直视手术患者ＣＰＢ 期间采用低血氧分压能够显著降低由ＣＰＢ 引发的心肝肾损伤、炎症反应及氧化应激。 [ABSTRACT FROM AUTHOR]