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目的:急性主动脉夹层(AAD)手术围术期并发症发病率和病死率均明显高于其他心脏手术。炎症反应是影响主动脉夹层手术患者围术期结局的重要危险因素。本文研究急性夹层手术在体外循环(CPB)期间应用50%氙气静态膨肺,观察其对围术期炎性因子变化的影响情况。方法:选择发病14d以内的急性主动脉夹层并拟行急诊手术的患者100例,随机分为两组:对照组CPB期间用50%氧气静态膨肺,气道压力控制在5cm H_2O;氙气组CPB期间用50%氙气静态膨肺,气道压力控制在5cm H_2O(1cm H_2O=0.098k Pa)。记录患者围术期的一般临床指标,并于诱导后(T_0)、术后10min(T_1)、术后6h(T_2)和术后24h(T_3)抽取患者静脉血测定炎性因子,包括白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、前列环素I2(PGI_2)和血栓素B2(TXB_2)。结果:两组患者术前的一般临床指标、围术期血流动力学及血生化学指标差异无统计学意义。住院期间对照组死亡5例,氙气组死亡6例,二者之间差异无统计学意义;存活患者中气管切开患者对照组为3例,氙气组无气管切开患者;术后机械通气时间,对照组为16.5h(14.75,36),氙气组为21.25h(13.5,44.25),两者之间差异无统计学意义。IL-6(P值分别为0.000及0.000)、IL-10(P值分别为0.000及0.001)、TNFα(P值分别为0.012及0.025)、TXB_2(P值分别为0.000及0.001)时间效应及时间治疗交互作用明显。T0至T1阶段,氙气组IL-6,TNF-α及TXB_2分别下降了23.5%、9.1%及30.2%,对应值在对照组分别上升了10.8%、26.2%及26.4%;IL-10在氙气组上升了28%,在对照组下降了7.5%。结论:CPB期间给予50%静态膨肺可以有效缓解患者围术期的炎症反应
OBJECTIVE: The incidence and mortality of perioperative complications in patients with acute aortic dissection (AAD) are significantly higher than those of other cardiac operations. Inflammatory reaction is an important risk factor affecting perioperative outcomes in patients with aortic dissection. This study was to investigate the effect of 50% xenon static inflating lung during cardiopulmonary bypass (CPB) on the changes of inflammatory factors in acute mesenteric surgery. Methods: A total of 100 patients with acute aortic dissection within 14 days of onset and emergency surgery were randomly divided into two groups: control group with 50% oxygen static inflation and control of airway pressure at 5 cm H 2 O during CPB; During static expansion of lungs with 50% xenon, airway pressure was controlled at 5 cm H 2 O (1 cm H 2 O = 0.098 kPa). The general clinical parameters of patients during perioperative period were recorded. Inflammatory factors, including interleukin - 1 (IL - 1β) and interleukin - 6 (IL - 10) were measured in venous blood after induction (T 0), at 10 min after T 1, at 6 h after T 2 and at T 3 after operation. IL-6, IL-10, TNF-α, PGI_2 and TXB2. Results: There were no significant differences in the general clinical indexes, perioperative hemodynamics and blood biochemical indexes between the two groups before operation. There were 5 deaths in the control group and 6 deaths in the xenon group during hospitalization. There was no significant difference between the two groups. In the surviving patients, the control group was 3 and the patients in the xenon group were without tracheotomy. The duration of mechanical ventilation , Control group was 16.5h (14.75,36), xenon group was 21.25h (13.5,44.25), the difference was not statistically significant. IL-6 (P 0.000 0.000), IL-10 (P 0.000 0.000), TNFα (P 0.012 and 0.025, respectively) and TXB 2 (P 0.000 0.000) Time treatment interaction obvious. The levels of IL-6, TNF-αand TXB_2 decreased by 23.5%, 9.1% and 30.2% in xenon group during the period from T0 to T1, respectively. The corresponding values increased by 10.8%, 26.2% and 26.4% The group increased by 28% and decreased by 7.5% in the control group. Conclusion: 50% of static inflation during CPB can effectively relieve perioperative inflammatory reaction