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目的研究羟乙基淀粉治疗体外循环出现的急性肺损伤(ALI)的临床疗效。方法选择2014年5月—2015年5月于贵州医科大学附属医院在体外循环下行心脏瓣膜置换术患者60例,随机分成研究组(H组)30例和对照组(R组)30例。入室后H组输注羟乙基淀粉(6%万汶),R组输注乳酸钠林格液,监测术前(T1)、体外循环开始(T2)、术后(T3)的心率、中心静脉压、动脉血压、动脉血气分析指标,并计算氧合指数。结果心率的时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异无统计学意义(P>0.05),组间比较,差异无统计学意义(P>0.05);中心静脉压时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异有统计学意义(P<0.05),组间比较,差异有统计学意义(P<0.05);动脉血压时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异有统计学意义(P<0.05),组间比较,差异有统计学意义(P<0.05);氧合指数时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异无统计学意义(P>0.05),组间比较,差异有统计学意义(P<0.05)。两组心率比较,差异无统计学意义(P>0.05);T2、T3时H组中心静脉压、动脉血压高于R组,差异有统计学意义(P<0.05);T3时H组氧合指数高于R组,差异有统计学意义(P<0.05)。白介素6(IL-6)时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异有统计学意义(P<0.05),组间比较,差异有统计学意义(P<0.05);肿瘤坏死因子α(TNF-α)水平时间和方法间无交互作用,差异无统计学意义(P>0.05),时间间比较,差异有统计学意义(P<0.05),组间比较,差异有统计学意义(P<0.05)。T1时两组患者IL-6和TNF-α比较,差异无统计学意义(P>0.05)。T2及T3时H组IL-6和TNF-α低于R组,差异有统计学意义(P<0.05);T2及T3两组IL-6和TNF-α高于T1时,差异有统计学意义(P<0.05),T3时H组IL-6和TNF-α低于T2时,差异有统计学意义(P<0.05)。结论羟乙基淀粉应用于心脏手术体外循环后患者,可有效改善氧合,减轻炎性反应,从而改善急性肺损伤的症状,提高患者的生活质量。
Objective To study the clinical efficacy of hydroxyethyl starch in the treatment of acute lung injury (ALI) during cardiopulmonary bypass. Methods Sixty patients undergoing cardiopulmonary valve replacement surgery at the Affiliated Hospital of Guizhou Medical University from May 2014 to May 2015 were randomly divided into study group (H group), 30 cases and control group (R group), 30 cases. The rats in group R were infused with hydroxyethyl starch (6% wenweian) and the R group were infused with Ringer’s solution. The ventricular remodeling was performed before and after cardiopulmonary bypass (T2), postoperative cardiopulmonary (T3) Pressure, arterial blood pressure, arterial blood gas analysis indicators, and calculate the oxygenation index. Results There was no interaction between time and method of heart rate (P> 0.05). There was no significant difference in time between two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05 (P> 0.05). There was no significant difference between central venous pressure time and method (P> 0.05), and the difference was statistically significant (P <0.05). There was a significant difference between the two groups (P 0.05). There was no significant difference in the time and method of arterial blood pressure between the two groups (P 0.05). There were significant differences between the two groups in time (P 0.05) P <0.05). There was no significant difference in the time between oxygenation index and the method (P> 0.05), but the difference was not statistically significant (P> 0.05) between the two groups. The difference was statistically significant Significance (P <0.05). There was no significant difference in heart rate between the two groups (P> 0.05); at T2 and T3, the central venous pressure and arterial pressure in H group were higher than those in R group (P <0.05) The index was higher than R group, the difference was statistically significant (P <0.05). Interleukin-6 (IL-6) had no interaction between the time and the method, the difference was not statistically significant (P> 0.05), the difference was statistically significant (P <0.05), the difference was statistically significant (P0.05) .There was no significant difference in the time and method of tumor necrosis factor α (TNF-α) between the two groups (P> 0.05), the difference was statistically significant (P <0.05) The differences between the two groups were statistically significant (P <0.05). There were no significant differences in IL-6 and TNF-α between the two groups at T1 (P> 0.05). The levels of IL-6 and TNF-α in H group were lower than those in R group at T2 and T3 (P <0.05), while the levels of IL-6 and TNF-α in T2 and T3 groups were higher than that of T1 (P <0.05). There was a significant difference in the levels of IL-6 and TNF-α between the two groups at T3 (P <0.05). Conclusion Hydroxyethyl starch can be used in patients after cardiopulmonary bypass of cardiac surgery, which can effectively improve oxygenation and reduce the inflammatory reaction, thus improving the symptoms of acute lung injury and improving the quality of life of patients.