改良超滤对体外循环后血浆可溶性细胞间黏附分子与肿瘤坏死因子α浓度变化的影响

目的探讨改良超滤在减轻体外循环（CPB）后炎症反应及内皮细胞损伤中的作用。方法将40例在CPB下行心脏直视手术的患者随机分为两组，超滤组（n=20）：在CPB后行改良超滤；对照组（n=20）：不进行改良超滤。两组患者分别于术前、CPB结束、术后4h和术后24h取静脉血，用酶联免疫吸附法测定血浆可溶性细胞间黏附分子-1（sICAM-1）和放射免疫法测定肿瘤坏死因子α（TNF—α）浓度，并进行比较。结果对照组患者术后4h和24h血浆sICAM-1浓度明显高于术前（P〈0．01）。术前和CPB结束时超滤组sICAM-1与对照组比较差异无统计学意义，术后4h和24h则明显低于对照组（269．6±33．8／μg／Lvs．409．6±37．3／μg／L，245．9±32．2／μg／Lvs．379．3±35．7μg／L；P〈0．01）。CPB结束时和术后4h超滤组TNF—α浓度明显高于术前（P〈0．01），但术后24h基本恢复至术前水平（0．177±0．024μg／Lvs．0．172±0．030μg／L；P〉0．05）。对照组CPB结束时TNF—α浓度明显高于术前（P〈0．01），术后4h和24h浓度有所下降，但仍较术前高（0．264±0．045μg／Lvs．0．174±0．033μg／L，0．218±0．028μg／Lvs．0．174±0．033μg／L；P〈0．05）。结论CPB可诱导炎症反应致内皮细胞损伤或激活，而改良超滤可明显减轻这些不良反应，有利于患者术后的恢复。

The Effects of Modified Ultrafiltration on the Concentration Changes of Soluble Intercellular Adhesion Molecules and Tumor Necrosis Factor α after Cardiopulmonary Bypass

Objective To investigate the effect of modified ultrafiltration on attenuating the inflammatory reaction and endothelial cell activation or damage after cardiopulmonary bypass （CPB）. Methods Forty patients undergoing cardiac operation with CPB were randomly divided into two groups. Ultrafiltration group （n = 20）： patients underwent modified ultrafiltration after CPB; control group （n = 20）： without ultrafiltration. Plasma concentrations of soluble intercellular adhesion molecules-1 （sICAM-1）and tumor necrosis factor-α （TNF-α） were determined with enzyme linked immunosorbent assay and radioimmunity pre-operatively （baseline）, at the end of CPB, 4h and 24h post-operatively in both groups. Results The concentrations of sICAM-1 in the control group at 4h and 24h post-operatively were higher than those pre-operatively （P〈0. 01）. The concentrations sICAM-1 in the ultrafiltration group in pre-operatively and at the end of CPB were not significantly different from that of the control group, but they were lower at 4h and 24h post-operatively （269.6± 33.8μ/L vs. 409. 6± 37.3μ/L, 245. 9± 32. 2μ/ L vs. 379. 3 ± 35.7μ/L ;P〈0. 01）. In the ultrafiltration group, the concentration of TNF-α at the end of CPB and 4h post-operatively were higher than that pre-operatively （P〈0. 01）. The concentrations of TNF-α in the ultrafiltration group at 24h post-operatively recoved to the pre-operative level （0. 177 ± 0. 024μ/L vs. 0. 172 ± 0. 030μ/L; P〉 0.05）. In the control group, the concentration of TNF-α was higher at the end of CPB than that pre-operatively （P〈 0. 01）, and decreased slightly at 4h and 24h post-operatively, but remained higher than those pre-operatively （0. 264±0. 045μ/L vs. 0. 174±0. 033μ/L, 0. 218±0. 028μ/L vs. 0. 174±0. 033μ/L; P〈0. 05）. Conclusion CPB is known to induce inflammatory reaction and endothelial cell activation or damage. Modified ultrafiltration appears to attenuate these adverse reactions and is beneficial to postoper