Clinical Study On The Effect Of Continuous Pulmonary Artery Perfusion With Oxygenated Warm Blood Contain Three Different Drugs On Lung Injury During Cardiopulmonary Bypass

Objective To study and to evaluate the protective effect of continuous pulmonary artery perfusion with oxygenated blood with L-arginine methylprednisolone ligustrazine and mechanical ventilation on lung injury during cardiopulmonary bypass(CPB). Methods 60 cases of mitral valve replacement were randomly divided into 4 groups: groupⅠ, control group (n=15) CPB with continuous pulmonary artery perfusion with oxygenated warm Blood and mechanical ventilation; groupⅡ, continuous pulmonary artery perfusion with oxygenated blood contain L-arginine (200mg/kg) with mechanical ventilation (n=15); groupⅢ, continuous pulmonary artery perfusion with oxygenated blood contain methylprednisolone(5mg/kg) with mechanical ventilation (n=15); group IV continuous pulmonary artery perfusion with oxygenated blood contain ligustrazine (5mg/kg) with mechanical ventilation (n=15).Vital sign observation system was established at the same time of intravenous respiration combined anesthesia, all of the patients received mechanical ventilation after single lumen endotracheal intubations. All 4 groups received routine procedure of CPB.Blood samples were drawn from the radial artery at the following time points: after anaesthesia,1 hours after opening of aorta, being taken back to ICU 0,6,12,24 hours. The expression of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-10(IL-10) were evaluated by ELISA test. Result (1).All the patients were totally recovered. (2). TNF-αlevel in group with drug were lower than groupⅠ(P﹤0.05),but group IV andⅢlower than groupⅡ(P﹤0.05),no significant difference exists between group IV andⅢ.(3)IL-6 level in group with drug were lower than groupⅠ(P﹤0.05),but group IV andⅡlower than groupⅢ(P﹤0.05),group IV lower than groupⅡ(P﹤0.05). (4)IL-10 level in group with drug were higher than groupⅠ(P﹤0.05),but group IV andⅡhigher than groupⅢ(P﹤0.05),group IV higher than groupⅡ(P﹤0.05). Conclusion continuous pulmonary artery perfusion with any of the there durgs and oxygenated blood during cardiopulmonary bypass can release of inflammatory factor and increase antiinflamatory factor ,play better lung protecting role than control group. Group ligustrazine domenstate best lung protecting function.Group L-arginine perform a better lung protecting effect in reduce IL-6 and increase IL-10 than group methylprednisolone,but weaker in reduce TNF-α.