乌司他丁对儿童体外循环后肺的保护作用

目的 观察乌司他丁对先天性心脏病(先心病)患儿肺动脉高压体外循环(CPB)后细胞因子释放及肺功能的影响,探讨其可能的肺保护机制.方法 心功能Ⅱ～Ⅲ级的50例先心病(房间隔缺损或室间隔缺损)患儿,随机分为乌司他丁组和对照组,每组各25例.乌司他丁组予乌司他丁2万U·kg-1,1/3量用于CPB前麻醉后,1/3加入预充液,另1/3复温时给予.对照组用等容积9 g·L-1盐水代替.记录术中呼吸道峰压.分别于麻醉诱导后、主动脉开放后30 min、2 h、24 h采集动脉血,应用酶联免疫吸附试验法测定其血浆TNF-α、基质金属蛋白酶-9(MMP-9)水平.结果 二组呼吸道峰压在停CPB和术后均有升高,但对照组升高更显著(Pa<0.05);CPB后患儿TNF-α、MMP-9生成明显增加(Pa<0.05),乌司他丁组在主动脉开放30 min、24 h MMP-9、TNF-α水平均较对照组明显降低(Pa<0.01).结论 CPB前应用乌司他丁能有效抑制TNF-α、MMP-9释放,降低呼吸道压力,减轻CPB后急性肺损伤,具有一定的肺保护作用.     

氨茶碱与乌司他丁合用对婴幼儿体外循环炎症介质的影响

目的探讨氨茶碱与乌司他丁合用对体外循环(CPB)术后炎症介质的影响。方法选取体重≤7 kg的单纯室间隔缺损新生儿及低体重婴幼儿60例,随机分为氨茶碱组(A组)、乌司他丁组(U组)、联合组(AU组)和对照组(C组),每组15例。A组麻醉诱导后静脉注射氨茶碱5mg/kg,并在CPB过程中按0.5 mg/kg/h维持;U组在CPB过程中按10000 U/kg应用乌司他丁;AU组联合应用上述两种药物;C组未给予氨茶碱及乌司他丁。选取CPB启动前(t_1)、结束时(t_2)、CPB后1 h(t_3)、CPB后6 h(t_4)、CPB后24 h(t_5)5个时间点,检测血浆肿瘤坏死因子α(TNF-α)、白细胞介素6 (IL-6)、白细胞介素8(IL-8)和白细胞介素10(IL-10)以及CPB后1 h支气管肺泡灌洗液(BALF)中TNF-α、IL-6水平。结果血浆TNF-α、IL-6、IL-8和IL-10在t_2开始升高,t_3达峰值;BALF中TNF-α、IL-6水平高于血浆水平。与C组相比,A组、U组、AU组CPB结束后各时间点血浆TNF-α、IL-6、IL-8、IL-10及BALF中TNF-α、IL-6水平明显降低(P<0.05),AU组效果更明显。结论氨茶碱和乌司他丁可抑制体外循环心内直视手术患儿围术期促炎细胞因子的释放,并上调抗炎细胞因子,减轻体外循环引起的急性炎症反应,两者联合应用有协同作用。     

噬血细胞综合征患儿细胞因子变化及意义

目的探讨血清IL-2、IL-6、IL-8、TNF-α及IFN-γ在噬血细胞综合征(HPS)患儿中的变化及意义。方法应用流式细胞术检测32例HPS患儿血清IL-2、IL-6、IL-8、TNF-α及IFN-γ水平变化,并与50例健康对照组进行比较。结果 32例HPS患儿血清细胞因子IL-2、IL-6、IL-8、TNF-α、IFN-γ水平均升高。IL-6、TNF-α明显升高,与健康对照组相比较,差异均有统计学意义(Pa<0.01);IL-2、IL-8、IFN-γ升高,与健康对照组比较,差异均有统计学意义(Pa<0.05)。结论细胞因子IL-2、IL-6 IL-8、TNF-α、IFN-γ在HPS的发病过程中起重要作用,检测细胞因子对于HPS的诊断、治疗和预后具有一定的临床意义。     

过敏性紫癜患儿血清白细胞介素-4、-6、-8及肿瘤坏死因子-α表达的意义

目的 探讨血清白细胞介素(IL)-4、-6、-8及肿瘤坏死因子α(TNF-α)在过敏性紫癜(HSP)患儿中表达及其临床意义.方法 采用ELISA检测45例HSP患儿(其中20例并肾脏损害)及43例健康儿童血清IL-4、-6、-8及TNF-α水平,比较有和无并肾损害HSP患儿及HSP患儿与健康儿童细胞因子水平;分析IL-4、-6、-8与TNF-α是否存在相关关系.结果 1.HSP患儿血清IL-4、-6、-8及TNF-α水平高于健康对照组(P＜0.01);2.无肾损害HSP与紫癜性肾炎(HSPN)组血清IL-4、-6、-8水平均无统计学差异;HSPN组TNF-α水平高于无肾损害HSP组;3.HSP血清TNF-α水平与IL-4无相关(r=0.278 P＞0.05);HSP患儿血清TNF-α水平与IL-8正相关(r=0.524 P＜0.01).HSP患儿血清TNF-α水平与IL-6正相关(r=0.670 P＜0.01).结论 细胞因子IL-4、-6、-8和TNF-α可能参与HSP/HSPN发病过程.     

婴儿肝炎综合征血清和胆汁成分变化的意义

目的探讨婴儿肝炎综合征（IHS）患儿血清及胆汁成分变化的临床意义。方法采用全自动生化分析仪检测42例IHS患儿及对照组16例婴儿的血清及胆汁中总胆红素（TB）、直接胆红素（DB）、ALT、γ-谷氨酰转肽酶（γ-GT）、总胆汁酸（TBA）水平,采用双抗体夹心ELISA法检测血清及胆汁中白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的水平。婴儿肝炎综合征患儿分为淤胆型组（18例）和肝炎型组（24例）。结果1.IHS组血清TB、DB、ALT、γ-GT、TBA、IL-6、TNF-α均明显升高（Pa〈0.05）;胆汁中TB、DB、γ-GT、TBA均明显降低（Pa〈0.05）,IL-6、TNF-α高于对照组（Pa〈0.05）。2.淤胆型血清TB、DB、γ-GT、TBA、IL-6、TNF-α均高于肝炎型（Pa〈0.05）;淤胆型胆汁中IL-6、TNF-α高于肝炎型（Pa〈0.05）,γ-GT、TBA则低于肝炎型（Pa〈0.05）。3.IHS患儿胆汁IL-6、TNF-α分别与血清DB、TBA、γ-GT呈正相关（Pa〈0.05）。结论IHS患儿均存在不同程度胆汁淤积,淤胆型IHS胆汁淤积程度更严重,胆汁IL-6、TNF-α可能参与IHS胆汁淤积的发生过程,且与疾病严重程度有关,检测胆汁中TB、DB、γ-GT、TBA、IL-6、TNF-α水平可为判断IHS患儿病情程度及估计预后提供依据。     

先天性心脏病患儿体外循环期血浆8-异前列腺素F2α水平变化及N-乙酰半胱氨酸的干预作用

目的 探讨先天性心脏病(CHD)患儿体外循环期(CPB)血浆8-异前列腺素F2α(8-iso-PGF2α)水平变化及其意义,并观察N-乙酰半胱氨酸(NAC)的干预效果,以期为CPB脂质过氧化损伤的防治提供新途径.方法 选取需要CPB下行外科手术的CHD患儿30例,根据术前NAC应用与否分为NAC未处理组和NAC预处理组,每组各15例.NAC未处理组术前常规处理;NAC预处理组患儿在术前常规处理的基础上,于术前3 d开始口服NAC[10 mg/(kg·次),2次/d,连用3 d].二组分别于入院时(T0)、CPB转流前(T1)、主动脉阻断15 min时(T2)及主动脉开放后30 min后(T3)抽取静脉血,检测各组血浆8-iso-PGF2α水平.结果 随着时间的推移和CPB的应用,二组患儿CPB期间血浆8-iso-PGF2α水平逐渐升高.二组患儿8-iso-PGF2α水平在T0与T1时间点差异均无统计学意义(Pa>0.05).CPB期间,二组患儿8-iso-PGF2α水平在T2、T3时间点水平较T0、T1均明显升高(Pa<0.05),但NAC预处理组在T2、T3时间点血浆8-iso-PGF2α水平均低于NAC未处理组(Pa<0.05).结论 CHD患儿CPB期间缺血再灌注可导致脂质过氧化损伤,使血浆8-iso-PGF2α升高,NAC预处理可使血中8-iso-PGF2α降低,对CPB期间心肌缺血再灌注所致的脂质过氧化损伤有一定的保护作用.     

肺炎支原体肺炎患儿血清巨噬细胞移动抑制因子、肿瘤坏死因子-α、白细胞介素-6表达的意义

目的 探讨巨噬细胞移动抑制因子(MIF) 、TNF-α及IL-6在肺炎支原体肺炎(MPP)患儿血清中的表达水平及意义.方法 采用ELISA法测定42例急性期和26例恢复期MPP患儿、25例细菌性肺炎患儿(细菌性肺炎组)及30例健康儿童(健康对照组)血清MIF、TNF-α及IL-1β水平,并对急性期和恢复期MPP患儿血清MIF水平与血清TNF-α 、IL-6水平进行相关性分析.结果 MPP急性期患儿血清MIF、TNF-α、IL-6水平明显高于MPP恢复期、细菌性肺炎组及健康对照组,差异均有统计学意义(P均＜0.01,0.05);MPP恢复期与对照组比较差异无统计学意义(P＞0.05);细菌性肺炎组MIF、TNF-α及IL-6水平亦高于健康对照组(P均＜0.05);MPP急性期MIF与TNF-α、IL-6呈正相关(r=0.76、0.82,P均＜0.05);恢复期MIF与TNF-α、IL-6无相关性(r=0.26、0.31,P均＞0.05).结论 MIF 、TNF-α及IL-6可能参与MPP发病过程,联合检测对MPP病情判断及预后评估具有重要的参考价值.     

婴儿先天性心脏病体外循环术后肾损伤分析

目的：探讨婴儿先天性心脏病（简称先心病）体外循环（CPB）术后肾损伤情况。方法：选取我院2009年10月至2010年7月期间CPB下行先心病手术的婴儿40 例，分别于转流前、手术结束时、术后2 h、术后6 h、术后24 h用酶联免疫吸附法（ELISA）检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、半胱氨酸蛋白酶抑制剂C (CysC)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)浓度。常规生化方法检测术前及术后血清肌酐（Cr）及尿素氮（BUN）浓度。结果：术前与术后血清Cr及BUN均在正常范围内；血清TNF-α、IL-6和尿NAG浓度在CPB后均有显著性升高（P<0.05）。相关性分析提示血清TNF-α分别与尿NAG、血清CysC呈正相关（r分别为0.195，0.190，均P<0.05），血清IL-6与尿NAG亦呈正相关（r=0.278，P<0.01）；血清CysC和尿NAG检测出肾损伤的阳性率显著高于血清Cr或BUN(均P<0.01)。结论：CPB能引起婴儿急性肾损伤，可能与血清中TNF-α和IL-6的浓度增高相关。血清CysC和尿NAG可作为反映肾功能变化较敏感的指标。     

肺炎支原体肺炎患儿IL-6、IL-10、TNF-α的变化

目的探讨细胞因子IL-6、IL-10、TNF-α在肺炎支原体肺炎(MPP)患儿急性期支气管肺泡灌洗液(BALF)和血清中的变化及临床意义。方法采用双抗体夹心ELISA法对30例MPP患儿急性期和20例无肺部病变的对照组患儿BALF和血清中IL-6、IL-10、TNF-α水平进行测定。结果 MPP患儿BALF和血清中IL-6、IL-10、TNF-α水平在发病的急性期明显高于对照组(P均<0.05),并且BALF中IL-6、IL-10、TNF-α浓度高于血清中相应细胞因子浓度(P均<0.05),血清IL-6、IL-10、TNF-α与相应的BALF中IL-6、IL-10、TNF-α有相关性(r=0.953～0.992,P均<0.05)。结论 MPP患儿BALF和血清中有明显的细胞因子变化,IL-6、IL-10、TNF-α可能参与了MPP的发病。     

自身免疫甲状腺病患儿细胞因子的失衡及其在发病中的作用

目的探讨自身免疫甲状腺病(AITD)儿童血清、干扰素(IFN-γ)、肿瘤坏死因子(TNF-α)、IL-4、IL-6水平变化及在AITD发病中的作用。方法采用双抗体夹心ELISA法对30例弥散性毒性甲状腺肿(GD)和20例桥本甲状腺炎(HT)患儿及30例对照组患儿分别检测血清IFN-γ、TNF-α、IL-4、IL-6水平。结果与对照组相比,GD患儿血清IL-4、6水平明显升高,IFN-γ/IL-4、TNF-α/IL-6值均明显下降(Pa<0.05);HT患儿(GD)IFN-γ、TNF-α水平、IFN-γ/IL-4、TNF-α/IL-6均显著升高(Pa<0.05),GD较HT患儿明显升高(P<0.05),IFN-γ水平HT较GD患儿显著升高(P<0.05)。HT组IFN-γ、TNF-α阳性表达明显高于IL-4、6,而GD组IL-4、6明显高于IFN-γ、TNF-α。结论GD患儿以分泌IL-4、6的Th2浸润为主,而HT患儿则以分泌IFN-γ、TNF-α的Th1浸润为主。儿童AITD的发病与Th1/Th2失衡及其分泌的Th1/Th2细胞因子密切相关。     

Cytokines in acute rheumatic fever

Plasma concentrations of inflammatory cytokines (IL-1α, IL-1β, IL-6, IL-8 and TNFα) were determined by ELISA in 27 patients with acute rheumatic fever (RF), 12 with only arthritis (RFA) and 15 with rheumatic heart disease (RHD), before, during and after treatment. Altogether, significant increases in TNFα, IL-8 and IL-6 levels were observed in the acute phase as compared to the data found during and after treatment. No significant differences were observed for the other cytokines. Elevations of one or more of the inflammatory cytokines were observed in 9 of 12 patients with RFA, and 12 of 15 with RHD. Increase of TNFα (6/9) and IL-8 (5/9) levels were higher in RHD patients with cardiac failure. These cytokines were below the detection limits on day 7 of treatment in all 22 patients, except in two, and in all 10 days after treatment. Conclusions?These findings suggest that inflammatory cytokines, as TNFα, IL-8 and IL-6, may play a patho‐genic role in rheumatic fever.     

吸入一氧化氮对危重先天性心脏病体外循环婴幼儿肺表面活性物质的影响

目的 探讨吸入一氧化氮(NO)对婴幼儿危重先天性心脏病(先心病)体外循环术(CPB)中肺表面活性物质的影响.方法 将30例室间隔缺损伴重度肺动脉高压的婴幼儿随机分为对照组和NO组,NO组在CPB期间吸入40×10-6NO.CPB前和术后气管插管未拔前0～1 h,1～2 h,2～3 h测定气道压、吸入氧浓度和呼气末二氧化碳浓度,并分别在同时点采动脉血进行血气分析,计算肺泡死腔率(VDhD/VT)、肺泡动脉血氧分压差[P(A-a)O2]、动脉血氧含量(CaO2)和肺泡氧合指数(OI),记录术后呼吸机支持时间.同时各时相点以少量生理盐水灌洗气道,分别测定气道吸出物中总磷脂(TPL)、饱和卵磷脂(SatPC)、总蛋白(TP)值,计算SatPC/TPL和SatPC/TP.结果 与对照组相比,NO组VD/VTP(A-a)O2明显下降(P<0.01),OI、CaO2升高(P<0.01);两组CPB后SatPC/TPL和SatPC/TP较CPB前明显降低(P<0.01).NO组SatPC/TPL和SatPC/TP下降的幅度明显小于对照组(P<0.01).结论 婴幼儿危重先心病CPB中存在明显的肺损害,表现为一些亚临床性肺功能损伤.吸入一定浓度的NO对CPB期间肺功能有保护作用.     

脓毒症患儿营养状况的评估

目的 本研究旨在评价感染严重程度与血清白蛋白、细胞因子(IL-6、IL-8及TNF-α)及血浆中氨基酸浓度的关系,以利于早期发现脓毒症患儿的营养不良,为其合理的营养支持提供理论依据.方法 根据感染严重程度将患儿分为脓毒症组(52例)、严重脓毒症组(41例),并设正常对照组(300例).在使用血制品及营养支持前测定各组患儿血浆中自蛋白、氨基酸浓度及细胞因子(IL-6、IL-8及TNF-α)水平.结果 严重脓毒症组患儿均存在低蛋白血症,其IL-6、IL-8和TNF-α浓度分别为(193.95±74.11)ng/L、(481.33±186.58)ng/L、(21.00±9.43)ng/L,明显高于脓毒症组和正常对照组(P＜0.01);其天冬氨酸、精氨酸、甘氨酸含量分别为(23.6±8.5)μmol/L、(6.1±4.7)μmol/L、(101.4±60.6)μmol/L,明显低于脓毒症组和正常对照组(P＜0.01).结论 严重脓毒症患儿均存在低蛋白血症,其天冬氨酸、精氨酸、甘氨酸等具有抗氧化和免疫调节作用的氨基酸含量明显降低,对其早期开始营养支持可能会改善临床预后.     

严重脓毒症患儿连续性静脉－静脉血液滤过疗效及治疗时间研究

目的对严重脓毒症患儿常规治疗基础上行连续性静脉一静脉血液滤过（continuous renous-venous hemofiltration, CVVH）治疗,通过监测不同时刻降钙素原（procalcitonin,PCT）、白细胞介素（interleukin,IL）一6、肿瘤坏死因子（tumor necrosis factor,TNF）-α、IL-10等因子浓度的变化,探讨血液净化对严重脓毒症患儿炎性反应的疗效及最佳治疗时间。方法选取符合诊断标准的严重脓毒症患儿20例,在常规治疗基础上行CVVH治疗48h。选取CVVH治疗0h、6h、12h、24h、48h及CVVH治疗停止后12h6个时间点,分别检测外周静脉血清PCT、TNF—α、IL-6、IL-10的浓度。结果经CVVH治疗后各时间点,PCT浓度呈逐渐下降趋势,与0h相比,差异均有统计学意义（P〈0．05）。治疗6h内PCT降低幅度最大,由0h的（6．79±1．75）μg／L降至（4．46±1．42）μg/L,至12hPCT浓度降至最低,为（3．51±1．45）μg/L,24h后各时间点PCT浓度较前略有回升,但与治疗后12hPCT浓度比较,差异无统计学意义（P〉0．05）。CVVH治疗后,TNF-α、IL-6、IL-10浓度值随治疗时间延长逐步降低,各时刻浓度与0h比较差异均有统计学意义（P〈0．05）。治疗停止后12h TNF-α、IL-6、IL-10浓度略有回升,但与治疗48h相比差异无统计学意义（P〉0．05）。TNF—α、IL-6浓度在治疗24h后各时间点差异无统计学意义（P〉0．05）。IL-10浓度在治疗12h之后各时间点差异无统计学意义（P〉0．05）。结论CWH能有效清除严重脓毒症患儿体内的TNF-α、IL-6、IL-10等炎性因子,降低PCT水平。CVVH清除炎性介质最佳有效时间为24—48h。     

升主动脉注射鱼精蛋白对体外循环后婴儿细胞因子与补体的影响

目的 通过升主动脉及上腔静脉注射鱼精蛋白,观察和评价不同注射途径对体外循环后婴儿血浆IL-6、TNF-α、G3a、G5a浓度的影响.方法 年龄≤12个月行体外循环心内直视手术的患儿60例,数字随机分为实验组(经升主动脉注射鱼精蛋白组,n=30)和对照组(经上腔静脉注射鱼精蛋白组,n=30).于注射鱼精蛋白前(T1)、注射鱼精蛋白后1 h(T7)取右心房肝素抗凝血1 ml,用ELISA法测定血浆IL-6、TNF-α、G3a、C5a浓度.分别于注射鱼精蛋白前、注射鱼精蛋白后1 min、2min、3 min、5 min、10min测左侧桡动脉动脉收缩压.结果 注射鱼精蛋白前两组患儿血浆IL-6、TNF-α、C3a、C5a浓度无统计学差异(P＞0.05);对照组患儿在注射鱼精蛋白后1 h血浆IL-6浓度(25.4±10.7)ng/L、TNF-α浓度(26.1±0.2)ng/L、C3a浓度(23.0±3.5)μg/L、G5a浓度(0.9±0.1)μg/L,均较注射鱼精蛋白前显著增多(P＜0.01);实验组患儿在注射鱼精蛋白后1h血浆TNF-α浓度(25.2±0.4)ng/L、C3a浓度(19.6±3.5)μg/L、C5a浓度(0.8±0.1)μg/L均较注射鱼精蛋白前无显著性差异(P＞0.05);IL-6浓度均较注射鱼精蛋白前有统计学差异(19.2±10.2)ng/L(P＜0.05);对照组患儿在注射鱼精蛋白后1 h血浆IL-6、TNF-α、C3a、C5a浓度较实验组显著增高(P＜0.01).注射鱼精蛋白前两组患儿左侧桡动脉收缩压分别为(90.9±4.9)mmHg、(89.8±6.0)mmHg无统计学差异(P＞0.05);注射鱼精蛋白后1 min、2 min、3 min两组患儿左侧桡动脉收缩压分别为(86.3±4.7)mm-Hg、(85.1±5.4)mmHg、(79.2±4.4)mmHg、(80.1±5.1)mmHg、(82.5±4.5)mmHg、(84.1±4.5)mmHg,较注射鱼精蛋白前均下降(P＜0.01);两组患儿同时点左侧桡动脉收缩压相互比较无统计学差异(P＞0.05).结论 升主动脉途径注射鱼精蛋白可显著减少体外循环后婴儿血浆IL-6、TNF-α、G3a、G5a浓度.

Abstract：

Objective To study the effects of protamine on complement activation and cytokine generation in infants with cardiopulmonary bypass. Methods Sixty infants under 1 year of age underwent cardiopulmonary bypass (CPB) from heart surgery were recruited in this study, and randomly grouped into 2 groups. Experimental group had 30 patients, who received protamine injection via ascending aorta. The control group also had 30 patients, but they received protamine injection via superior vena cava. Blood samples were collected from right atrium at the time prior to protamine injection (T1) and 1 hour after the injection (T2). IL-6, TNF-α, C3a and Csa plasma levels were measured by ELISA. Left radial artery systolic arterial pressures (SAPs) were measured at the time prior to protamine injection (Time 1), 1 min (Time 2), 2 min (Time 3), 3 min (Time 4), 5 min (Time 5), and 10min (Time 6) after the injection. Results At Time 1, IL-6, TNF-α, C3a and C5a plasma levels were not significantly different between the control group and the experimental group (P＞0. 05). In the patients of control group, IL-6 (25. 4 ± 10. 7 ng/L), TNF-α (22. 1 3. 5μg/l), C3a (23. 0 ± 3. 5 μg/L), and C5a (0. 9 ± 0. 1 μg/L) at Time 7 were significantly increased compared with these at Time 1 (P＜0. 01). In the patients of experimental group, levels of TNF-α (25. 2 ± 0. 4 ng/L), C3a (19. 6 ± 3. 5μg/L) and Csa (0. 8 ± 0. 1 μg/L) at Time 7 were not significantly different from those at Time 1 (P＞0. 05), but IL-6 (19. 2± 10. 2 ng/L) at Time 7 was significantly increased than that at Time 1 (P＜0. 05). Before injection, no difference of left radial artery SAPs was found between experimental group and control group (P＜0. 05). After injection, the left radial artery SAPs of the patients of the 2 groups were decreased compared with the SAPs before injection (P＜0. 05), but no difference between experimental and control group was found (P＞0. 05). Conclusions Protamine injection via ascending aorta decreased IL-6, TNF-α, C3a and C5a plasma levels in the infants with cardiopulmonary bypass.     

保护性肺通气对婴儿围体外循环期肺功能的影响

目的 观察体外循环(CPB)中间断肺通气对婴儿肺功能的影响.方法 选取60例1岁以内行室间隔缺损修补术的患儿,分为2组:对照组(n=30)于CPB开始后停止通气;处理组(n=30)于CPB开始心脏停跳后膨肺[用手挤压气囊,使气道压力升到15～20 cm H2O(1 cmH2O=0.098 kPa),维持3～5 s,重复5次],将肺内血液排出,然后静态膨肺(3～5 cm H2O),并每隔10 min膨肺5次.两组患儿均于腔静脉开放后恢复机械通气.检测CPB开始前及CPB结束后2、6、12、24和48 h共6个时点的氧合指数、动脉血氧分压/肺泡氧分压、肺泡-动脉氧分压差和呼吸指数等肺功能指标.结果 在CPB后2、6、12 h,处理组氧合指数、动脉血氧分压/肺泡氧分压高于对照组(P＜0.05);在CPB后2、6、12、48 h,处理组肺泡-动脉氧分压差低于对照组(P＜0.05);在CPB后6、12 h,处理组呼吸指数低于对照组(P＜0.05).结论 在婴儿CPB过程中持续静态膨肺并间断压力膨肺,可以改善术后早期肺的氧合功能,有较好的肺保护作用.     

Complement Activation, Cytokines, and Adhesion Molecules in Children Undergoing Cardiac Surgery with or without Cardiopulmonary Bypass

The effect of cardiopulmonary bypass (CPB) on various blood parameters in children undergoing major cardiovascular surgery was investigated in a prospective clinical study. Blood samples of children with CPB (CPB group, n= 18) or without CPB (control, n= 12) were collected before, during, and after surgery. The concentration of routine laboratory parameters, components of the complement system (C3, C4, C5, C1 inhibitor, total hemolytic complement, C3d, and C5a), circulating interleukins (IL-6 and IL-8) and soluble adhesion molecules (sICAM-1 and sE-selectin) were determined. In both groups of patients the serum concentrations of C3, C4, C5, and C1 inhibitor were significantly affected by the treatments (p < 0.001), decreased immediately after onset of anesthesia, were minimal during surgery, and increased thereafter. No significant differences in the kinetics of these parameters were detectable between CPB and control group. In the CPB group the activation of the alternative pathway (increased C3d) was found to be a specific response (p= 0.005), but also in the control group C3d and C5a concentration increased significantly (p < 0.022), indicating complement activation. None of the effects that would be expected after activation of the complement system were specific for the CPB group. In both groups the serum levels of IL-6 increased dramatically during and/or after surgery (p= 0.001), and IL-8 was detectable after surgery in 10/12 control patients. The concentration of sICAM-1 and sE-selectin decreased during surgery (p < 0.04) and later did not increase above baseline. Our data suggest that increased serum levels of inflammation mediators and increased consumption of complement and adhesion molecules occur during cardiovascular surgery. Although complement activation and ICAM-1 consumption are more pronounced in the CPB patients, none of these changes occurs exclusively in the CPB group. We conclude, therefore, that these changes are the combined effect of anesthesia, surgical trauma, and endothelial lesions. Additional, undefined CPB-induced reactions may also contribute the postoperative morbidity.     

Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation

Aim: Posthaemorrhagic ventricular dilatation (PHVD) is closely associated with white matter damage and neurological disability in the preterm infant. Proinflammatory cytokines have been implicated in the pathogenesis of white matter injury and subsequent cerebral palsy. The aim of this study was to determine the levels of proinflammatory cytokines in cerebrospinal fluid (CSF) from preterm infants with PHVD and to correlate the levels to white matter damage and neurodevelopmental outcome. Methods: CSF samples were obtained from 24 preterm infants with expanding PHVD and 19 preterm infants with normal ultrasound. Tumour necrosis factor-3 (TNF-3), interleukin-13 (IL-13), interleukin-8 (IL-8) and interferon-3 (IFN-3) in CSF were measured by enzyme-linked immunosorbent assay, and IL-6 was measured by bioassay. Results: The concentrations of TNF-3, IL-13, IL-6 and IL-8 were significantly elevated in CSF from infants with PHVD. TNF-3 was detected in 43% of PHVD infants and 11% of controls ( p = 0.04). IL-13 was detected in 67% of PHVD infants and 0% of controls (p 3 0.0001). The concentrations of IL-6 were 368 (145-460) pg ml 31 in the PHVD group and 30 (25-41) pg ml 31 in the control group (p 3 0.0001), and those of IL-8 were 3000 (1620-3400) pg ml 31 in the PHVD group and 35 (0-230) pg ml 31 in the control group (p 3 0.0001). Cytokine concentrations did not correlate with white matter lesions on ultrasound, shunt dependence or neurological outcome within the PHVD group. Conclusion: There was an intense and prolonged inflammatory reaction in CSF from preterm infants with PHVD and a high risk for subsequent white matter injury and permanent neurological impairment.     

丙种球蛋白治疗RSV毛细支气管炎的临床及免疫学研究

为评估静脉注射丙种球蛋白(IVIG)治疗呼吸道合胞病毒毛细支气管炎(RSV毛支)的临床疗效及免疫学机理,比较26例IVIG治疗组和30例常规治疗组患儿症状体征消失时间及住院天数,同时检测治疗前后血清白介素6(IL-6)、白介素8(IL-8)及肿瘤坏死因子-α(TNF-α)水平。结果:与常规治疗组相比,IVIG治疗组喘憋和肺部体征消失时间明显缩短(4.0天±1.1天比5.2天±1.4天,5.4天±1.5天比6.5天±1.8天,P分别<0.001和<0.05),而住院天数则无显著差异(9.0天±2.2天比10.3天±3.1天,P>0.05)。治疗前两组患儿血清IL-6、IL-8及TNF-α水平均高于正常对照组;IVIG治疗后3种细胞因子水平明显降低.但与常规治疗组相比无显著差异。结论:细胞因子参与了RSV毛支的发病过程。IVIG治疗有较确切的临床疗效,但单剂(0.25g/kg)对血清细胞因子的抑制作用不明显。