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论著:体外循环术围术期血中游离脂肪酸含量与肺损伤的相关性
Elevated Free Fatty Acid Level Contributes to Lung Injury after Cardiopulmonary Bypass
虞敏 周黎瑾 董莉亚 王利民 高远 施盛 袁忠祥
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作者单位:上海交通大学附属第一人民医院心血管外科
中文关键字:体外循环;游离脂肪酸;肺损伤
英文关键字:Cardiopulmonary bypass; Free fatty acid; Lung injury
中文摘要:目的:探讨体外循环术(cardiopulmonary bypass,CPB)围术期患者血中游离脂肪酸(free fatty acids, FFA)含量与肺损伤的关系及其可能机制。方法:收集60例CPB下心脏手术患者,在4个围术期时点(手术开始前、肝素化后10 min、鱼精蛋白中和后和术后2 h)的血样。检测4个时点血样中的FFA、三酰甘油(TG)和总胆固醇(TC)含量;在围术期术后2 h检测机械通气时的动脉血气(PO2)并记录此时的呼吸机主要参数;同时检测术后2 h血样中的炎性指标,包括血白介素6(IL 6)、肿瘤坏死因子α(TNF α)、内皮素-1(ET 1)和细胞间黏附因子(ICAM 1)。以术后2 h氧合指数<200作为肺损伤低氧血症的标准,将CPB术后患者分为低氧血症组与正常组,分析低氧血症与临床资料及血样中各项检测指标的相关性。结果:术后2 h有22例患者(36.7%)发生低氧血症。Logistic回归分析显示年龄大、冠状动脉旁路移植术、CPB时间长以及术后FFA浓度高是低氧血症的危险因素(P<0.05)。CPB术中,FFA在肝素化后迅速上升,可达术前的2~5倍,术中和术后逐步下降,但术后仍高于术前。术后 2 h时,血FFA含量与氧合指数间存在负相关性(P<0.001);FFA 与血ICAM 1存在相关性(P<0.001), 但FFA水平与IL 6、TNF α、ET 1水平均无相关性。术前和术后TG均与术后FFA呈显著相关(术前:P<0.01;术后:P<0.001)。结论:CPB术中伴有FFA明显升高,FFA在术后2 h的含量与术后肺损伤显著相关,其机制可能为高FFA引起肺血管内皮功能改变,诱发白细胞黏附和肺血管通透性增高。
英文摘要:Objective:To investigate the relationship between free fatty acid (FFA) and lung injury during the perioperative period of cardiopulmonary bypass(CPB). Methods: Sixty patients underwent cardiac surgery on CPB were included, and their clinical information was recorded in detail. The blood samples of the patients were collected at baseline, 10 min after heparinization, after neutralization by protamine sulfate and 2 h after the operation. The levels of FFA, triglyceride (TG) and total cholesterol (TC) were detected in the blood samples. Aterial blood gas and data of mechanical ventilation were recorded 2 hours after the operation. interleukin (IL) 6, endothelin (ET) 1, tumor necrosis factor (TNF) α and intercellular adhesion molecule 1 (ICAM 1) were detected in the blood samples at 2 h after operation. Hypoxemia was defined as oxygenation index less than 200, and its relationship with the clinical and laboratory parameters to the lung injury was analyzed. Results: There were 22 cases of hypoxemia 2 hours after the operation. Age, coronary artery bypass graft, duration of cardiopulmonary bapass and postoperative FFA level were risk factors of hypoxemia. During CPB, the FFA level increased rapidly to 2 5 folds after heparinization, then droped, but it was still higher after CPB than that before CPB. The FFA level had significant inverse correlation with oxygenation index(P<0.001), and had significant positive correlation with the levels of ICAM 1(P<0.001), while it had no correlation with the levels of IL 6,TNF α and ET 1. FFA had significant square correlation with preoperative TG (P<0.01) and with postoperative TG (P<0.001). Conclusions: Elevated FFA level contributed to lung injury after CPB. The possible mechanism may be that high level of FFA induces pulmonary vascular endothelium abnormality followed by leukocytes adhesion and increased vascular permeability.
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