无肝素化体外循环转流及早期炎性因子的表达

目的探讨采用鱼精蛋白-琼脂糖凝胶进行无肝素化体外循环(CPB)的可行性。方法选择健康成年家犬12只,犬龄2～3岁,雌雄不限,体重20～28(23.3±3.7)kg。按随机数字表法将12只犬分为两组,每组6只,肝素化组:行常规CPB;非肝素化组:采用鱼精蛋白-琼脂糖凝胶吸附血浆凝血因子,即行无肝素化CPB。于CPB开始时和CPB1 h、2 h、3 h采用酶联免疫吸附法(ELISA)测定动脉血中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)的浓度,并进行比较。结果非肝素化组和肝素化组犬在CPB过程中肉眼观察膜肺内均未见血栓形成,全血激活凝血时间(ACT)始终>480 s,生命体征均平稳。两组血浆TNF-α、IL-6和IL-8浓度在CPB开始时差异无统计学意义,非肝素化组血浆TNF-α和IL-8于CPB 1 h、CPB 2 h和CPB 3 h时均高于肝素化组CPB3 h TNF-α:(156.48±16.65)ng/L vs.(115.87±15.63)ng/L,t=4.356,P=0.001;CPB 3 h IL-8:(365.38±46.18)ng/L vs.(299.29±34.50)ng/L,t=2.808,P=0.019],而两组IL-6浓度差异无统计学意义(P>0.05)。结论依靠鱼精蛋白-琼脂糖凝胶对凝血因子进行吸附,以进行无肝素化CPB效果明确,但具有一定的促进全身炎症反应效应。

Heparin-free Cardiopulmonary Bypass and Early Systemic Inflammatory Response

Objective To explore the feasibility of using protamine-agarose gel to achieve heparin-free cardiopulmonary bypass(CPB).Methods A total of 12 healthy adult dogs were chosen,the dogs were between 2-3 years old,either male or female,with their mean body weight of 23.3±3.7 kg(ranging from 20 to 28 kg).All the dogs were randomly divided into two groups with 6 dogs in each group.In the heparinized group,conventional CPB technique was used;in the non-heparinized group,protamine-agarose gel column was used to absorb plasma clotting factors in CPB without use of heparin.At the beginning of CPB and 1 h,2 h,3 h after CPB,arterial blood samples were collected from dogs in both groups.The expression levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were measured by enzyme-linked immunosorbent assay(ELISA)and compared.Results There was no thrombus formation in the membrane oxygenators during CPB by naked eye observation in both groups.Activated coagulation time(ACT)was always greater than 480 s during CPB.The vital signs of the dogs were all stable during CPB.At the beginning of CPB,there was no statistical difference in plasma concentrations of TNF-α,IL-6,IL-8 between the two groups.At 1 h,2 h and 3 h after CPB,the expression levels of TNF-α and IL-8 of the non-heparinized group were significantly higher than those of the heparinized group(CPB 3 h TNF-α:156.48±16.65 ng/L vs.115.87±15.63 ng/L,t=4.356,P=0.001;CPB 3 h IL-8: 365.38±46.18 ng/L vs.299.29±34.50 ng/L,t=2.808,P=0.019).There was no statistical difference in the expression level of IL-6 between the two groups(P > 0.05).Conclusion Using protamine-agarose gel to absorb plasma clotting factors is an effective technique to establish heparin-free CPB.But this method can induce significant systemic inflammatory response.