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沈嘉渝, 张尔永, 胡佳. KL-6与体外循环中行持续低潮气量通气的成年瓣膜患者围术期肺氧合功能改变的相关性研究[J]. 四川大学学报(医学版), 2019, 50(3): 350-356.
引用本文: 沈嘉渝, 张尔永, 胡佳. KL-6与体外循环中行持续低潮气量通气的成年瓣膜患者围术期肺氧合功能改变的相关性研究[J]. 四川大学学报(医学版), 2019, 50(3): 350-356.
SHEN Jia-yu, ZHANG Er-yong, HU Jia. Correlation of Krebs Von Den Lungen-6(KL-6) Expression and Perioperative Pulmonary Function in Adults Receiving Continuing Low-volume Ventilation during Valve Surgery[J]. Journal of Sichuan University (Medical Sciences), 2019, 50(3): 350-356.
Citation: SHEN Jia-yu, ZHANG Er-yong, HU Jia. Correlation of Krebs Von Den Lungen-6(KL-6) Expression and Perioperative Pulmonary Function in Adults Receiving Continuing Low-volume Ventilation during Valve Surgery[J]. Journal of Sichuan University (Medical Sciences), 2019, 50(3): 350-356.

KL-6与体外循环中行持续低潮气量通气的成年瓣膜患者围术期肺氧合功能改变的相关性研究

Correlation of Krebs Von Den Lungen-6(KL-6) Expression and Perioperative Pulmonary Function in Adults Receiving Continuing Low-volume Ventilation during Valve Surgery

  • 摘要:
      目的  初步探讨体外循环(CPB)术中持续低潮气量通气对成年瓣膜患者体内涎液化糖链抗原-6(KL-6)的表达水平及患者围术期肺氧合功能变化的影响,评估KL-6与此类患者围术期氧合功能改变的相关性。
      方法  连续纳入2017年9月至2018年1月在我科接受心脏瓣膜手术的成年患者60例,随机分为对照组(n=30例,CPB期间未接受机械通气)和试验组(n=30例,CPB期间接受持续低潮气量通气)。动态监测患者围术期血清学指标及肺氧合功能变化情况,比较两组患者围术期临床结局,并分析KL-6表达水平与患者围术期肺氧合功能改变的相关性。
      结果  对照组及试验组患者CPB术后血清及肺泡灌洗液中KL-6水平差异均有统计学意义(P<0.05)。两组患者CPB术后氧合指数随时间呈先升高后下降趋势(P<0.05),肺泡-动脉氧分压差随时间上下波动,差异均无统计学意义。直线相关分析发现,血清KL-6水平与氧合指数呈负相关(r=-0.525, P=0.003),与肺泡-动脉氧分压差呈正相关(r=0.489, P=0.006)。两组患者围术期临床结局均无明显差异(P>0.05)。
      结论  术中持续低潮气量通气可有效抑制患者体内KL-6的表达,但对围术期临床结局无明显影响。KL-6表达水平可有效反映围术期肺氧合功能的改变。

     

    Abstract:
      Objective  To investigate the influence of continuous low-volume ventilation in cardiopulmonary bypass (CPB) on the expression of krebs von den lungen-6 (KL-6) and perioperative pulmonary function in adults undergoing valve surgery.
      Methods  From 2017 Sept. to 2018 Jan., 60 patients who received valve replacement surgery were prospectively comprised in this study. We randomly allocated these patients into control group (n=30, non-ventilation) and experimental group (n=30, continuous low-volume ventilation during CPB). At different perioperative time points, we identified the dynamic changes of pulmonary function and biomarkers which expressed in serum and bronchoalveolar lavage fluid (BALF). Meanwhile, we also compared perioperative clinical outcomes of the two groups.
      Results   The expression of serum KL-6 and BALF KL-6 in the two groups were both statistically significant(P<0.05). The oxygenation index increased with time and reached to the top point at T1, then subsequently decreased with time (P<0.05). The alveolar-arterial oxygen tension difference (PA-aO2) in the two groups fluctuate with time, the differences have no statistical significance. According to linear correlation, the serum KL-6 level was negatively correlated with oxygenation indexes (r=-0.525, P=0.003), while it was positively correlated with PA-aO2 (r=0.489, P=0.006). There were no significant differences between the two groups in clinical outcomes.
      Conclusion  Continuing low-volume ventilation during CPB could decrease the expression level of KL-6, while it has no significant influence on perioperative outcomes.

     

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