摘要
目的 分析体外循环下心脏瓣膜置换术中呼出气冷凝液介质(exhaled breath condensate,EBC)浓度变化及其与术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的关系.方法 选取2019年1月—2023年12月期间河南大学第一附属医院78例心脏瓣膜置换术手术患者,根据患者是否合并ARDS分为ARDS组41例和非ARDS组37例,比较两组EBC中8-异前列腺素F2a(8-isoPGF2a)、肿瘤坏死因子-α(TNF-α)、白细胞介素8(IL-8)、白细胞介素6(IL-6)浓度变化,及其与心脏瓣膜置换术手术患者术后ARDS的相关性.结果 经重复测量方差分析,EBC中8-isopgF2a、TNF-α、IL-6、IL-8的时点、组间、交互比较,均有统计学意义(P＜0.05);经LSD-t检验,与气管插管后立即(T1)时点比较,两组手术结束即刻(T2)、手术后2 h(T3)、手术后 6 h(T4)时点 EBC 中 8-isopgF2a、TNF-α、IL-6、IL-8 升高(P＜0.05),且与非 ARDS 组比较,ARDS 组T2、T3、T4 时点 EBC 中 8-isopgF2a、TNF-α、IL-6、IL-8 更高(P＜0.05).经 Spearman 分析,EBC 中 T2、T3、T4时点的8-isopgF2a、TNF-α、IL-6、IL-8与心脏瓣膜置换术手术术后ARDS呈正相关(P＜0.05).结论 心脏瓣膜置换术手术患者EBC中8-isopgF2a、TNF-α、IL-6、IL-8升高,且术后ARDS患者的EBC中8-isopgF2a、TNF-α、IL-6、IL-8水平高于术后非ARDS患者.
Abstract
Objective To analyzed the changes in exhaled breath condensate(EBC)concentration during cardiac valve replacement surgery under extracorporeal circulation and its relationship with postoperative acute respiratory distress syn-drome(ARDS).Methods Selected 78 patients undergoing heart valve replacement surgery in the First Affiliated Hos-pital of Henan University from January 2019 to December 2023.They were divided into an ARDS group of 41 patients and a non ARDS group of 37 patients based on whether they had ARDS.Compared the concentration changes of 8-iso-prostaglandinF2a(8-isoPGF2a),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),and inter-leukin-6(IL-6)between two groups of EBC,and their correlations with postoperative ARDS in patients undergoing heart valve replacement surgery were analyzed.Results After repeated measures analysis of variance,the time points,between-group,and interaction comparisons of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC were statistically significant(P＜0.05);according to the LSD-t test,compared with the immediate time point after tracheal intubation(T1),the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at the immediate time point after surgery(T2),2 hours post-surgery(T3),and 6 hours post-sur-gery(T4)were elevated in both groups(P＜0.05),and compared with the non-ARDS group,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at T2,T3,and T4 time points were higher in the ARDS group(P＜0.05).According to Spearman analysis,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC at T2,T3,and T4 time points were positively correlated with postoperative ARDS after cardiac valve replacement surgery(P＜0.05).Conclusion In patients undergoing heart valve replacement surgery,the levels of 8-isopgF2a,TNF-α,IL-6,and IL-8 in EBC are elevated,and the levels of these markers in EBC are higher in postoperative patients with ARDS compared to those without ARDS.
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