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| 心肺转流下心脏瓣膜置换术患者TNF-α和8-isoPGF2α浓度与术后ARDS相关性研究 |
| Correlation between TNF-α and 8-isoPGF2α concentrations and postoperative ARDS in patients undergoing cardiac valve replacement under cardiopulmonary bypass |
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| DOI：10.12089/jca.2020.03.002 |
| 中文关键词: 心肺转流 呼出气冷凝液 肿瘤坏死因子α 8-异前列腺素F2α 急性呼吸窘迫综合征 |
| 英文关键词: Cardiopulmonary bypass Exhaled breath condensate Tumor necrosis factor-α 8-iso-prostaglandin F2α Acute respiratory distress syndrome |
| 基金项目:江苏省卫生计生委科研课题(H2017055) |
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| 中文摘要: |
目的 检测心肺转流(CPB)下心脏瓣膜置换术患者呼出气冷凝液(EBC)中肿瘤坏死因子α(TNF-α)和8-异前列腺素F2α(8-isoPGF2α)的浓度变化,探讨该变化与患者术后急性呼吸窘迫综合征(ARDS)的关系。
方法 选择择期在CPB下行心脏瓣膜置换术患者49例,男28例,女21例,年龄34～80岁,BMI 20～29 kg/m2,ASA Ⅱ 或 Ⅲ级。根据术后是否发生ARDS,将患者分为ARDS组(A组)和非ARDS组(N组)。于气管插管后即刻(T0)、停CPB后(T1)、手术结束前30 min(T2)、术后4 h(T3)采集患者EBC和桡动脉血标本,检测TNF-α和8-isoPGF2α浓度,分析EBC中两种指标浓度与血清中的相关性，并计算ROC曲线下面积(AUC)。记录两组术后呼吸支持时间、拔管时间、ICU停留时间和术后住院时间。记录两组术后高热、脑梗死、心律失常等发生情况。
结果 本研究中共27例(55%)患者术后发生ARDS。T1—T3时A组EBC中TNF-α和8-isoPGF2α浓度均明显高于N组(P<0.05)。两组血清中与EBC中TNF-α浓度明显正相关(P<0.05),8-isoPGF2α浓度明显正相关(P<0.05)。T1—T3时EBC中TNF-α浓度以及T1和T3时EBC中8-isoPGF2α浓度对ARDS的发生均具有中等诊断价值(P<0.05)。A组呼吸支持时间、拔管时间、ICU停留时间和术后住院时间明显长于N组(P<0.05)。两组术后高热、脑梗死和心律失常发生情况差异无统计学意义。
结论 呼出气冷凝液中TNF-α和8-isoPGF2α浓度与血清中浓度明显正相关，其用于预测心肺转流下心脏瓣膜置换术后急性呼吸窘迫综合征的发生具有一定的准确性。 |
| 英文摘要: |
Objective To evaluate the changes of tumor necrosis factor-α (TNF-α) and 8-iso-prostaglandin F2α (8-isoPGF2α) concentrations in exhaled breath condensate (EBC) in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB) and its relationship with postoperative acute respiratory distress syndrome (ARDS).
Methods Forty-nine patients undergoing elective cardiac valve replacement under cardiopulmonary bypass, 28 males and 21 females, aged 34-80 years, BMI 20-29 kg/m2, falling into ASA physical status Ⅱ or Ⅲ, were divided into group ARDS (group A) and group non-ARDS (group N) according to the diagnosis of postoperative ARDS. Radial artery blood and EBC samples were collected after tracheal intubation (T0), at the end of CPB (T1), 30 min before the end of operation (T2), 4 h after operation (T3). The concentrations of TNF-α and 8-isoPGF2α were detected, the relationship between EBC and serum concentrations was compared and the area under ROC curve (AUC) was calculated. The time of postoperative ventilator support, time to extubation, length of stay in the ICU, postoperative length of stay, postoperative hyperthermia, cerebral infarction and arrhythmia were recorded.
Results ARDS occurred in 27(55%) patients after CPB. Compared with group N, the concentrations of TNF-α and 8-isoPGF2α in EBC were significantly higher in group A at T1-T3 (P<0.05). The concentrations of TNF-α and 8-isoPGF2α in EBC were significantly positive correlated with that in serum (P<0.05), the concentrations of TNF-α at T1-T3 and concentrations of 8-isoPGF2α at T1 and T3 in EBC had moderate diagnostic value for ARDS (P<0.05). Compared with group N, postoperative ventilator support, time to extubation, length of stay in the ICU, and postoperative length of stay in group A were significantly longer (P<0.05). There were no significant differences in postoperative hyperthermia, cerebral infarction and arrhythmia between the two groups.
Conclusion The concentrations of TNF-α and 8-isoPGF2α in EBC were significantly positive correlated with that in serum, and they can be used to predict the incidence of acute respiratory distress syndrome after cardiac valve replacement under cardiopulmonary bypass. |
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