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目的研究腺苷预适应对体外循环中未成熟肺损伤的影响。方法选取2011年1月—2015年9月在河北工程大学附属医院行体外循环下先天性心脏病手术的60例患儿,随机分为对照组和腺苷预处理组,各30例。腺苷预处理组在麻醉诱导后经颈静脉留置管由微量泵给予腺苷,对照组给予等量0.9%氯化钠溶液泵入。分别于体外循环前(T_1)、体外循环开始40min(T_2)、体外循环停机(T_3)、停机后2h(T_4)、停机后6h(T_5)和停机后24h(T_6)6个不同时间点测定中性粒细胞计数、血浆中可溶性细胞黏附因子-1(s ICAM-1)与白介素8(IL-8)、肿瘤坏死因子α(TNF-α)水平。体外循环开始前及结束时取左右心房血测定中性粒细胞计数,计算中性粒细胞跨肺比值。结果中性粒细胞计数、TNF-α、s ICAM-1、IL-8均有交互作用,差异有统计学意义(P<0.05),中性粒细胞计数、TNF-α、s ICAM-1、IL-8时间间比较,差异有统计学意义(P<0.05),中性粒细胞计数、TNF-α、s ICAM-1、IL-8组间比较,差异有统计学意义(P<0.05);两组患儿外周血中性粒细胞计数、s ICAM-1、IL-8在T_2、T_3、T_4、T_5、T_6比较,差异有统计学意义(P<0.05),TNF-α在T_2、T_4、T_5、T_6比较,差异有统计学意义(P<0.05)。两组患儿体外循环时间、主动脉阻断时间比较,差异无统计学意义(P>0.05)。两组患儿中性粒细胞跨肺差值在体外循环停机时比较,差异有统计学意义(P<0.01)。结论腺苷能通过降低血中s ICAM-1、TNF-α、IL-8水平,减少中性粒细胞在肺内扣押程度,从而减轻体外循环对未成熟肺的损伤。
Objective To study the effect of adenosine preconditioning on immature lung injury during cardiopulmonary bypass. Methods Sixty children with congenital heart disease undergoing cardiopulmonary bypass undergoing cardiopulmonary bypass at Hebei University of Engineering Hospital from January 2011 to September 2015 were randomly divided into control group and adenosine preconditioning group, 30 cases in each group. In the adenosine preconditioning group, adenosine was administered by micropumps through the jugular vein indwelling catheter after induction of anesthesia, and the control group was pumped with 0.9% sodium chloride solution. Blood samples were collected at 6 different time points before (T_1), 40 minutes (T_2), T_3, 2 hours (T_4), 6 hours after T6 (T_6) Neutrophil count, s ICAM-1, IL-8 and TNF-α in plasma were measured. Before and at the end of cardiopulmonary bypass, left and right atrial blood was taken to determine neutrophil count and calculate the ratio of neutrophils to the lung. Results The neutrophil counts, TNF-α, s ICAM-1 and IL-8 all had interaction, the difference was statistically significant (P <0.05), neutrophil count, TNF- There was significant difference between the two groups (P <0.05), neutrophil count, TNF-α, s ICAM-1, (P <0.05). The levels of TNF-α in T_2, T_3, T_4, T_5 and T_6 in two groups were significantly different T_4, T_5, T_6, the difference was statistically significant (P <0.05). The two groups of children with cardiopulmonary bypass time, aortic cross-clamping time, the difference was not statistically significant (P> 0.05). Differences in the value of trans-pulmonary neutrophil across the two groups of children during cardiopulmonary bypass, the difference was statistically significant (P <0.01). Conclusions Adenosine can reduce the damage of immature lungs by decreasing the level of s ICAM-1, TNF-α and IL-8 in the blood and decreasing the degree of seizure of neutrophils in the lungs.