婴幼儿体外循环炎性因子的变化及其对心肌损伤的研究

目的探讨在婴幼儿体外循环中炎性因子浓度的变化及其对心肌损伤的研究。方法 20例施行先天性心脏病矫正术患儿分别在转流前（TI）,转流结束后20 min（T2）,术后2 h（T3）,术后6 h（T4）,术后12 h（T5）测定血白介素6（IL-6）、肿瘤坏死因子（TNF-α）、黏附因子（sICAM-1）、丙二醛（MDA）、超氧化物歧化酶（SOD）、磷酸激酶同工酶（CKMB）、磷酸激酶（CK）、肌酐蛋白（cTnI）和乳酸脱氢酶（LDH）的浓度。结果 CPB结束后T3、T4、T5时间CKMB、CK、LDH血浆浓度较T1时间均明显增高（P〈0.05）,T3时间cTnI血浆浓度较T1时间明显增高（P〈0.05）。CPB结束后T2、T3、T4、T5时间IL-6、TNF-α、MDA血浆浓度较T1时间明显增高（P〈0.05）,T3、T4、T5时间sICAM-1血浆浓度较T1时间明显增高,而SOD血浆浓度较T1时间明显降低（P〈0.05）。结论婴幼儿体外循环术后心肌功能存在损害,其机理可能与体外循环术后再灌注损伤,大量炎性细胞因子及氧自由基释放导致心肌及内皮损伤有关。

The study of the changes of the inflammatory mediators and myocardial injury in infants during cardopulmonary bypass

Objective To explore the changes of the inflammatory mediators and myocardial injury in infant cases during cardopulmonary bypass(CPB).Methods Twenty infants with congenital heart disease underwent open heart surgery.The concentration of IL-6,TNF-α,sICAM-1,MDA,SOD,CKMB,CK,CTn-I and LDH were measured before CPB(T1) and 20 min(T2),2 h(T3),6 h(T4),12 h(T5) after surgery.Results The concentration of CKMB,CK and LDH in serum at T2,T3,T4;cTn-I at T3;IL-6,TNF-α and MDA at T2,T3,T4,T5;and sICAM-l at T3,T4,T5 were all significantly higher than that at T1(P<0.05).However,the concentration of SOD significantly deceased at T3,T4,T5 compared to T1.Conclusion There’s myocardial injury in infants after open heart surgery with CPB.It’s may be associated with the damage of myocardial and endothelial cell after CPB due to re-perfusion injury resulting in releasing a great deal of inflammatory mediators and free radicals.