| 摘要: |
| ［摘要］ 目的 观察体外循环（CPB）冠状动脉旁路移植术中应用三氧自体血疗法（O3-AHT）对炎症反应及红细胞损伤的影响。方法 招募2024年10月至2025年12月于广东医科大学附属医院心血管外科拟行冠状动脉旁路移植术的冠状动脉粥样硬化性心脏病患者100例，采用随机数字表法将其分为观察组和对照组，各50例。对照组接受常规CPB心脏手术管理；观察组在CPB开始后30 min内接受O3-AHT，三氧浓度为30～40 μg/mL。比较两组麻醉诱导前（T0）、CPB开始30 min（T1）、CPB结束（T2）、术后24 h（T3）、术后48 h（T4）时间点炎症指标［白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）］、红细胞氧化应激指标［丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）］、血气分析指标［动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、pH］、常规血液学指标［血红蛋白（Hb）、红细胞比积（Hct）、红细胞计数（RBC）］以及溶血率。通过场发射扫描电子显微镜观察T0、T2、T4时间点红细胞形态。测定T0、T2、T4时间点带3蛋白（Band 3）水平。记录患者术后30 d内的预后情况。结果 观察组T1、T2、T3、T4时间点PaO2水平均显著高于对照组（P<0.05），T2、T4时间点PaCO2水平显著低于对照组（P<0.05），两组各时间点pH水平比较差异无统计学意义（P>0.05）。观察组T2、T3、T4时间点IL-6、TNF-α、CRP水平低于对照组，T3、T4时间点IL-8水平低于对照组，差异有统计学意义（P<0.05）。观察组T1、T2、T3、T4时间点红细胞MDA水平低于对照组，SOD水平高于对照组，差异有统计学意义（P<0.05）；T2、T3、T4时间点红细胞GSH-Px水平显著高于对照组（P<0.05）。观察组T1、T2、T3、T4时间点溶血率显著低于对照组（P<0.05），RBC水平显著高于对照组（P<0.05）；T2、T3、T4时间点Hb、Hct水平显著高于对照组（P<0.05）。观察组T2、T4时间点红细胞圆度优于对照组，直径大于对照组，Band 3表达水平高于对照组，差异有统计学意义（P<0.05）。观察组ICU停留时间和术后住院时间显著短于对照组（P<0.05）。两组低心排综合征、感染以及主要心血管不良事件（MACE）发生率比较差异无统计学意义（P>0.05）。结论 在30～40 μg/mL三氧浓度范围内，O3-AHT可有效抑制冠状动脉旁路移植术CPB期间的炎症反应，减轻红细胞氧化应激与膜损伤，改善术后肺功能，缩短ICU停留时间和术后住院时间。 |
| 关键词: 体外循环 三氧自体血疗法 炎症反应 红细胞 氧化应激 |
| DOI：10.3969/j.issn.1674-3806.2026.06.11 |
| 分类号:R 654 |
| 基金项目:恩泽疼痛管理医学研究项目（编号：ezmr2022-019） |
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| Effects of ozonated autohemotherapy on inflammatory response and red blood cell damage in on-pump coronary artery bypass grafting |
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LIN Zhonglin1,2, LI Daheng3, LI Mingliang4, ZHOU Chengbin2, TANG Jing3
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1.The First Clinical College, Guangdong Medical University, Zhanjiang 524000, China; 2.Department of Cardiovascular Surgery, Guangdong Provincial People′s Hospital of Southern Medical University, Guangzhou 510000, China; 3.Department of Anesthesiology,Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China; 4.Department of Cardiovascular Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
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| Abstract: |
| ［Abstract］ Objective To observe the effects of ozonated autohemotherapy(O3-AHT) on inflammatory response and red blood cell damage in on-pump coronary artery bypass grafting. Methods A total of 100 patients with coronary atherosclerotic heart disease who were scheduled for coronary artery bypass grafting in the Department of Cardiovascular Surgery of Affiliated Hospital of Guangdong Medical University from October 2024 to December 2025 were recruited. The patients were randomly divided into observation group and control group, with 50 patients in each group. The control group received conventional cardiopulmonary bypass(CPB) cardiac surgery management. The observation group received O3-AHT within 30 minutes after the start of CPB, with an ozone concentration of 30-40 μg/mL. The levels of inflammatory indicators［interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP)］, red blood cell oxidative stress indicators［malondialdehyde(MDA), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px)］, blood gas analysis indicators［partial pressure of arterial oxygen(PaO2), partial pressure of arterial carbon dioxide(PaCO2), pH］, routine blood test indicators［hemoglobin(Hb), hematocrit(Hct), red blood cell count(RBC)］ and hemolysis rate were compared between the two groups before anesthesia induction(T0), 30 minutes after the start of CPB(T1), at the end of CPB(T2), 24 hours after the operation(T3)and 48 hours after the operation(T4). The morphology of red blood cells was observed at T0, T2 and T4 time points using field emission scanning electron microscopy. The levels of band 3 protein(Band 3) were detected at T0, T2 and T4. The prognosis of the patients within 30 days after the operation was recorded. Results The levels of PaO2 at the time points of T1, T2, T3 and T4 in the observation group were significantly higher than those in the control group(P<0.05), while the levels of PaCO2 at the time points of T2 and T4 in the observation group were significantly lower than those in the control group(P<0.05). There was no statistically significant difference in the level of pH at each time point between the two groups(P>0.05). The levels of IL-6, TNF-α and CRP at the time points of T2, T3 and T4 in the observation group were lower than those in the control group, and the levels of IL-8 at the time points of T3 and T4 in the observation group were lower than those in the control group, with statistically significant differences(P<0.05). At the time points of T1, T2, T3 and T4, the levels of MDA in red blood cells in the observation group were higher than those in the control group; the levels of SOD in red blood cells in the observation group were significantly higher than those in the control group, with statistically significant differences(P<0.05); the levels of GSH-Px in red blood cells in the observation group were lower than those in the control group at T2, T3 and T4(P<0.05). At the time points of T1, T2, T3 and T4, the hemolysis rates in the observation group were significantly lower than those in the control group(P<0.05); the RBC levels in the observation group were significantly higher than those in the control group(P<0.05). At the time points of T2, T3 and T4, the levels of Hb and Hct in the observation group were significantly higher than those in the control group(P<0.05). At the time points of T2 and T4, the circularity of red blood cells in the observation group was better than that in the control group; the diameter of red blood cells in the observation group was greater than that in the control group; the expression levels of Band 3 in the observation group were higher than those in the control group, with statistically significant differences(P<0.05). The length of intensive care unit(ICU) stay and the length of postoperative hospital stay in the observation group were significantly shorter than those in the control group(P<0.05). There were no statistically significant differences in the incidence rates of low cardiac output syndrome, infection, and major adverse cardiovascular events(MACE) between the two groups(P>0.05). Conclusion In concentrations of ozone ranging from 30 μg/mL to 40 μg/mL, O3-AHT can effectively inhibit the inflammatory response during CPB in coronary artery bypass grafting, alleviate red blood cell oxidative stress and membrane damage, improve postoperative lung function, and shorten the length of ICU stay and the length of postoperative hospital stay. |
| Key words: Cardiopulmonary bypass(CPB) Ozonated autohemotherapy(O3-AHT) Inflammatory response Red blood cells Oxidative stress |
