摘要目的 讨论盐酸戊乙奎醚注射液在主动脉夹层手术中对肺缺血再灌注的影响.方法 选取2015年9月至2017年10月在郑州大学第二附属医院麻醉科因主动脉夹层行全弓置换手术的患者60例,数字随机分为两组:盐酸戊乙奎醚组(A组,30例)和对照组(B组,30例).A组于入手术室后静脉注射盐酸戊乙奎醚注射液0.05 mg/kg,B组给予等量生理盐水静脉注射.两组患者分别在麻醉开始前(T1)、体外循环开始前(T2)、体外循环后1 h(T3)、体外循环停机时(T4)、术后4 h(TS)及术后24 h(T6)测定血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白介素-1(IL-1)及氧合指数(OI)水平,统计分析患者术后呼吸机辅助时间及ICU驻留时间.结果 A组在T4、T5、T6时间点血清TNF-α为(0.10±0.08)、(0.13 ±0.02)、(0.23±0.17) mg/L;IL-6为(0.23±0.08)、(0.34±0.07)、(0.54±0.17) mg/L;IL-1为(0.62±0.14)、(1.02 ±0.27)、(1.44±0.4) mg/L.分别较B组(0.30 ±0.09)、(0.51 ±0.19)、(0.86±0.02)、(0.73±0.19)(1.33 ±0.13)、(1.98±0.13)、(0.93±0.19)、(1.43±0.66)、(2.04±0.45) mg/L均明显降低,差异均有统计学意义(均P＜0.05);氧合指数为(446.7±267.0)、(386.7±169.5)、(391.7±227.9)mmHg较B组(341.2±145.2)(299.5士98.7)、(275.0±127.3) mmHg升高,差异均具有统计学意义(均P＜0.05);患者术后呼吸机辅助时间及重症监护病房(ICU)驻留时间A组为(3.6±1.2)、(8.4±2.0)d较B组(4.3±1.8)、(10.0土2.2)d缩短明显,差异均具有统计学意义(均P ＜0.05).结论 在全弓置换术中,静脉给予盐酸戊乙奎醚注射液,能够降低术后血清TNF-α、IL-6、IL-1的释放,提高患者氧合指数,缩短术后呼吸机辅助及重症监护病房(ICU)驻留时间,减少肺缺血再灌注损伤,改善预后.

abstractsObjective To evaluate the effect of Penehyclidine Hydrochloride Injection on pulmonary ischemia-reperfusion in aortic dissection surgery.Methods This study was a prospective randomized controlled trial.Between September 2015 and October 2017 in the Second Affiliated Hospital of Zhengzhou University,60 patients with aortic dissection underwent total arch replacement surgery were randomly divided into penehyclidine hydrochloride group (group A 30 cases) and control group (group B 30 cases).Patients in group A were infused with penehyclidine hydrochloride 0.05 mg/kg after entering the operating room.Patients in group B were infused with the same dose of 0.9％ normal saline.Serum tumor necrosis factor (TNF-α),interleukin-6 (IL-6),interleukin-1 (IL-1) and oxygenation index (OI) before anesthesia (T1),before cardiopulmonary bypass (T2),1 h after cardiopulmonary bypass (T3),the end of cardiopulmonary bypass (T4),4 h after surgery (T5) and 24 h after surgery (T6) were measured.The time of postoperative ventilator support and ICU staywas recorded.Results At the time of T4,T5 and T6,the serum levels of TNF-α [(0.10 ± 0.08),(0.13 ± 0.02),(0.23 ± 0.17) mg/L],IL-6 [(0.23 ± 0.08),(0.34 ±0.07),(0.54 ±0.17) mg/L] and IL-1 [(0.62 ±0.14),(1.02 ±0.27),(1.44 ±0.40) mg/L] in group A were significantly lower than those in group B[(0.30 ±0.09),(0.51 ±0.19),(0.86 ±0.02) mg/L;(0.73 ±0.19),(1.33 ±0.13),(1.98 ±0.13) mg/L;(0.93 ±0.19),(1.43 ±0.66),(2.04 ± 0.45) mg/L].The OI was higher in group A [(446.7 ± 267.0),(386.7 ± 169.5),(391.7 ± 227.9) mmHg] than that of group B[(341.2 ± 145.2),(299.5 ±98.7),(275.0 ± 127.3) mmHg] (P ＜0.05).The time of ventilator support and ICU stay after operation was (3.6 ± 1.2) d,(8.4 ± 2.0) d in group A,which was shorter than that in group B [(4.3 ± 1.8),(10.0 ± 2.2) d],and there were statistical differences between the two groups (all P ＜ 0.05).Conclusions In total arch replacement,intravenous penehyclidine hydrochloride injection may decrease the release of serum TNF-α,IL-6,IL-1,improve oxygenation index,reduce lung ischemia-reperfusion injury,shorten the time of ventilator support and ICU stay after operation,and thus improve the prognosis of patients.