体外循环心内直视手术对机体免疫功能的影响

目的　研究体外循环心内直视手术对机体免疫功能的影响。方法　分别于体外循环（ＣＰＢ）转流前，转流结束及术后第１ 天、第３天和第７ 天随机抽取２６例行心内直视手术病人外周血，研究Ｔ淋巴细胞亚群、Ｂ淋巴细胞、白细胞介素－２（ＩＬ－２）、白细胞介素－２ 受体（ＩＬ－２Ｒ）和自然杀伤（ＮＫ）细胞活性。结果　ＣＤ２（Ｅ花环形成Ｔ淋巴细胞数）及ＣＤ８（抑制细胞毒Ｔ细胞）在ＣＰＢ结束时显著上升，ＣＤ３（Ｔ细胞总数）、ＣＤ４ （诱导、辅助Ｔ细胞）、ＣＤ１９ （Ｂ淋巴细胞总数）在ＣＰＢ开始后即下降，至术后第１ 天下降至最低；血清可溶性ＩＬ－２ 及淋巴细胞表面ＩＬ－２Ｒ也在ＣＰＢ手术后极度下降；ＮＫ细胞活性在ＣＰＢ术后第１ 天迅速降至最低点。这些变化均在术后１周内逐步恢复至术前水平。结论　ＣＰＢ心脏手术能明显影响机体的免疫功能，在ＣＰＢ术后第１天机体细胞免疫、体液免疫及非特异性免疫功能显著下降，至术后第７天才逐步恢复至术前水平，提示术后１周内应积极采取措施，预防和治疗由此导致的感染性疾病。

The Influence of Cardiopulmonary Bypass on the Immune Function under Open Heart Operations

Objective\ The influence of monary cardiopul bypass (CPB) on immune function in cardiac surgery was investigated. Methods\ Peripheral blood T lymphocyte subsets, B lymphocytes, interleukin 2, interleukin 2 receptor and natural killer cell activity were studied in 26 patients undergoing open heart operations before CPB and on of 1st, 3rd and 7th day postoperatively. Results\ The results showed that the numbers of CD\-2 and CD\-8 were remarkably increased during CPB, whereas the values of CD\-3, CD\-4, CD\-\{19\}, IL 2 and IL 2R showed significant decrease during CPB and 1 day postoperatively. Natural killer cell activity fell to the lowest level on the first day after CPB. All of these changes were returned to the preoperative levels by the seventh day postoperatively. Conclusion\ The results demonstrate that open heart operations in which CPB is used are responsible for the variation of the immune function of patients, and that the abilities of cellular immunity, humoral immunity and nonspecific immunity are remarkably inhibited on the first day after cardiac operation and returned to the normal level by the seventh day postoperatively. It is important to take active and effective measures to prevent and cure infectious diseases within the first week after operations with CPB.