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.

The effects of protamine on cytokines and complements in infants with cardiopulmonary bypass

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.