婴幼儿心内直视手术中应用环磷酸腺苷葡胺后血浆炎性细胞因子的变化

目的观察婴幼儿先心病患者在心内直视手术麻醉过程中应用环磷酸腺苷葡胺后血清中TNF-α、IL-6、IL-10的动态变化。方法选择实施心内直视手术的婴幼儿先心病患者40例,随机分为M-cAMP治疗组（A组）和对照组（B组）每组各20例,A组给予M-cAMP3 mg/kg,其中1 mg/kg于诱导前静脉注射,1 mg/kg稀释后输注至CPB开始,另1 mg/kg剂量加入预充液中经转机进入体内,B组给予等量生理盐水。分别于诱导前（T0）、主动脉开放后5 min（T1）、术毕（T2）、术后12 h（T3）采桡动脉血。结果40例婴幼儿先心病心内直视手术患者在转流前后开始CK-MB、TNF-α、IL-6、IL-10均有不同程度的升高,A组与B组比较差异具有统计学意义（P〈0.05）。结论婴幼儿心内直视手术麻醉过程中应用环磷酸腺苷葡胺可降低CK-MB、TNF-α、IL-6的产生,提高IL-10的活性,改善术后心功能不全及感染。

Influences of Meglumine Cyclic Adenosine Monophosphate Pretreatment on Variation of Serum Levels of Cytokines in Infant Patients with Congenital Heart Disease

Objective To investigate the effect of meglumine cyclic adenosine monophosphate （M-cAMP） on the serum levels of interleukin （IL）-6, IL-10 and tumor necrosis factor （TNF）-α in infant patients with congenital heart disease undergoing cardiopulmonary bypass （ CPB）. Methods ＂Forty infant patients with congenital heart disease were chosen and randomly allocated into M- cAMP treatment group （ Group A, n = 20） and control group （ Group B, n = 20）. In Group A, M-cAMP was injected intraveneous- ly before the induction of anesthesia, continuously infused before CPB, and then given during CPB （1mg/kg）. The serum levels of creatine kinase （CK）-MB, TNF-α, IL-6 and IL-10 were measured respectively before induction of anesthesia, and at 5 min after aortic declamping, the end of operation and 12h after operation. Results The serum levels Of CK-MB, TNF-α IL-6 and IL-10 in the 40 patients with heart operation were increased to some extent after CPB. But compared with that of Group B, CK-MB, TNF-α, IL-6 and IL-IO of Group A differed remarkably （ P 〈 0.05 ）. Conclusion M-cAMP not only decreases the production of CK-MB, TNF-α and IL-6, but also improves the activity of IL-10. It can thereby attenuate the heart failure and the infection after operation.