体外循环肺损伤机制及肺保护策略探究进展.docVIP

体外循环肺损伤机制及肺保护策略探究进展 　　[摘要] 体外循环肺损伤是心脏手术最常见的并发症之一，具有较高的死亡率。提高心脏手术麻醉的安全性及术后患者的预后，成为麻醉医师关注的重点。本文整合近年来相关研究资料，简述了体外循环肺损伤的机制是全身炎症反应综合征和肺缺血再灌注损伤，并就这两点主要机制为出发点，分析了非药物肺保护与药物肺保护特点；提出了深入研究体外循环肺损伤机制以及合理应用体外循环肺保护策略，对降低术后并发症、提高生存质量有重要的临床意义 [关键词] 肺保护；肺损伤；体外循环 [中图分类号] R654.1 [文献标识码] A [文章编号] 1673-7210（2016）12（b）-0032-04 Research progress of lung injury and lung protective strategies by cardiopulmonary bypass ZHENG Kun ZHANG Hong Department of Anesthesia， Affiliated Hospital of Zunyi Medical College， Guizhou Province， Zunyi 563003， China [Abstract] Cardiopulmonary bypass lung injury is one of the most common complications of cardiac surgery and has a high mortality rate. The prognosis of patients undergoing cardiac surgery and improve the safety of anesthesia， become the focus of attention of the anesthesiologist. This paper integrates the related research data in recent years， the mechanism of lung injury during cardiopulmonary bypass is a systemic inflammatory response syndrome and lung ischemia reperfusion injury， and the two main mechanisms as a starting point， analysis of non drug and drug lung protective lung protection characteristics； put forward in-depth research on cardiopulmonary bypass mechanism of lung injury and reasonable application of cardiopulmonary bypass lung protective strategies to reduce postoperative complications and improve the quality of life has important clinical significance. [Key words] Lung protection； Lung injury； Cardiopulmonary bypass 体外循环（cardiopulmonary bypass，CPB）肺损伤是心脏手术最常见的并发症，轻者仅是一过性轻微症状，重者表现为急性肺损伤或呼吸窘迫综合征[1]，由此所致的肺功能不全[2]，病死率高达50%～70%，是CPB术后患者死亡主要原因之一。因此，长期以来医学界一直在研究其发生机制，并寻找安全有效的肺保护策略 1 CPB肺损伤发生机制 CPB肺损伤的发生机制十分复杂，目前研究认为主要作用的因素是全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）和肺缺血-再灌注损伤（lung ischemia-reperfusion injury，I/R injury） 1.1 SIRS CPB是非生理循环，此过程中血液与非生物性的（CPB设备和管道等）接触、肝素或鱼精蛋白等其他药物的使用、血液成分的破?摹⒙樽碛胧质醯纫蛩氐贾虏固逑低车募せ睢⒛诙舅匮?症和炎症因子相互作用，引起一系列反应 1.1.1 补体激活 补体主要成分是一种具有酶促反应活性的糖蛋白，CPB过程会激活机体补体系统，血液中C3上升后，将产生补体