体外循环瓣膜置换手术围术期血浆细胞粘附分子浓度的变化

目的：观察瓣膜置换手术围术期外周血可溶性细胞粘附分子变化规律，并初步探讨其变化的临床意义。方法：连续随机地选取15例瓣膜置换病人，于体外循环（CPB）前、CPB开始后15min、CPB结束、CPB结束后1h及术后第1天晨5个时段抽取外周静脉血，用酶联免疫吸附试验法检测可溶性细胞粘附分子－1(sICAM-1)、可溶性血管细胞粘附分子－1(sVCAM-1)及可溶性P选择素（sP-selectin)的血浆浓度。结果：本组病人外周血可溶性细胞粘附分子浓度在CPB前在正常范围，CPB结束后显著增高（P＜0．05）。术后第1天晨、sICAM-1浓度下降至CPB前的基础水平，而sVCAM-1及sP-selectin仍维持较高水平（P＜0．05）。结论：CPB可引起血浆多种粘附分子浓度增高，这可能与CPB导致的全身炎症反应有关，并成为CPB术后再灌注损伤及术后心肺功能损害的重要原因。

Changes in Soluble Cell Adhesion Molecules during Cardi opulmonary Bypass in Patients Undergoing Valve Replacement

Objective:To explore the changes of soluble cell adhesion molecules during cardiopulmonary bypass (CPB) in patients who underwent valve replacement with prosthesis. Methods:Fifteen consecutive patients who underwent valve replacement were included in this group. Plasma concentrations of soluble P selectin, soluble ICAM 1 and soluble VCAM 1 were measured using enzyme linked immunosorbent assays (ELISA) at the following times:before CPB, after 15 minutes of CPB, at the end of CPB, one hour after CPB and the first postoperative day. Results:Before CPB, plasma levels of all three soluble cell adhesion molecules were in normal. All levels of three soluble cell adhesion molecules rose significantly at the end of CPB and the first hour after CPB. On the morning of the first postoperative day, plasma level of sICAM 1 decreased to baseline, but the plasma level of sVCAM 1 and sP selectin were still elevated ( P <0.05). Conclusion:CPB was associated with increased plasma levels of soluble adhesion molecules. The adhesion molecules may play an important role in the whole body inflammation resulted by CPB and also was the main reason of reperfusion injury after CPB.