联合应用常规及改良超滤对儿童体外循环围手术期细胞黏附分子及细胞因子的影响

目的:探讨儿童体外循环(CPB)心脏直视手术围手术期细胞黏附分子及细胞因子变化规律,以及联合应用常规和改良超滤对炎症介质的影响,并对联合超滤作用的临床意义进行讨论分析。方法:抽取儿童心脏直视手术患者19例,随机分为对照组与超滤组,对照组10例,超滤组9例,常规进行CPB心脏直视手术。超滤组在主动脉开放后开始常规超滤,CPB结束时进行改良超滤。分别于麻醉诱导后、主动脉阻断、主动脉开放或超滤前、CPB结束或超滤后、术后24h抽血检测血浆白介素-6(IL-6)、白介素-8(IL-8)、细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)的变化及超滤的影响。结果:对照组血IL-6、IL-8、ICAM-1、VCAM-1均在CPB结束时达到高峰,显著超过CPB前水平(P<0.01)。使用联合超滤能够明显降低血浆IL-6、IL-8及ICAM-1的浓度。与对照组相比,在超滤结束时明显降低(P<0.05,P<0.01,P<0.05)。而对VCAM-1影响较小,在CPB结束时两组间无差异(P>0.05)。结论:低温体外循环可以引起术后细胞黏附分子表达和细胞因子释放增多,联合应用常规及改良超滤不仅能减轻CPB术后组织水肿,提高血球压积和血红蛋白,同时能降低术后血浆细胞黏附分子及细胞因子的浓度。

Effects of combination of ultrafiltration of routine and improved method on the expression of cytokines and cell adhesion molecules in perioperative period of cardiopulmonary bypass in children

Objective:To investigate the changes of soluble cytokines and cell adhesion molecules in perioperative period of cardiopulmonary bypass(CPB) and to evaluate the effects of combined ultrafiltration on the expression of cytokines and cell adhesion molecules following CPB in children. Methods: Nineteen children with congenital heart disease were randomly divided into a control group(n = 10) and combined ultrafiltration(n = 9). Plasma levels of interleukin-6, interleukin-8, ICAM-1 and VCAM-1 were assessed. Results: The plasma levels of IL-6, IL-8,ICAM-1, VCAM-1 increased to peak value at the end of CPB. The use of combined ultrafiltration could lower the plasma levels of IL-6, IL-8 and ICAM-1. There were significant differences between the two groups at the end of CPB(P < 0.05, P < 0.01, P < 0.05 respectively). But the effect of combined ultrafiltration on the plasma level of VCAM-1 was not significant. Conclusion: After hypothermic CPB, cell adhesion molecules and cytokines are significantly increased. Using combined ultrafiltration during and after CPB can not only concentrate blood cell, alleviate the edima of tissues, but also lower the plasma levels of cytokines and adhesion molecules.