甲泼尼龙对小儿体外循环心脏术全身炎症反应的影响

目的研究甲泼尼龙(MP)对小儿体外循环(ECC)心脏手术全身炎症反应(SIR)的影响,探索较佳的MP的剂量、给药途径及给药时机。方法 44例先天性心脏病患儿均在全麻低温ECC下行畸形矫治术。随机分为四组,每组11例。组Ⅰ(G1)为对照组,组Ⅱ(G2)为小剂量组,组Ⅲ(G3)为小剂量静脉输入组,组Ⅳ(G4)为大剂量组。每例手术的患儿均在麻醉诱导后ECC前(T1),ECC开始后20 min(T2),ECC结束后20 min(T3),切口缝合后1 h(T4)4个时间点抽取血标本,酶联免疫吸附法(ELISA)检测白细胞介素(IL)-6、IL-8、IL-10及肿瘤坏死因子-α(TNF-α)。同时记录患儿的临床资料。结果①细胞因子的结果:4个组内TNF-α、IL-6、IL-8、IL-10的浓度在四个时间点逐渐升高,T4点达峰值。四种因子在T1点各组间无差异(P0.05)。TNF-α和IL-8浓度在T3,T4点G3组明显低于其他3组,差异有统计学意义(P0.05)。IL-6浓度在T2、T3、T4点G3组明显低于其他3组,差异有统计学意义。IL-10浓度在T2、T3、T4点的各组间差异有统计学意义,G3组在此3个时间点均最高。②临床结果:各组术前一般情况比较无差异。各组围术期检测的各项指标差异不显著。所有病例无切口感染及其他重大并发症。结论①ECC前使用MP能有效减少促炎细胞因子(TNF-α、IL-6、IL-8)的释放,而增加抗炎细胞因子(IL-10)的产生。MP可以抑制ECC引起的SIR。以术前中心静脉小剂量输入效果最明显。②本实验显示ECC前应用MP对临床结果的影响不明显。

Effects of methylprednisolone on systemic inflammatory response induced by extracorporeal circulation in pediatric cardiac operation

OBJECTIVE To study the effects of methylprednisolone（MP） on systemic inflammatory response（SIR） induced by extracorporeal circulation（ECC） in pediatric cardiac operations and to explore the optimal dosing,route,and timing of MP administration.METHODS 44 pediatric patients with congenital heart disease were performed cardiac defect repair under ECC,general anaesthesia and hypothermia conditions.They were randomized to four groups（n=11 /group）： ① control group,Group Ⅰ（G1）;② low dose group,Group Ⅱ（G2）;③ Group Ⅲ（G3）： MP 5mg/kg body weight infused via central venous after induction of anaesthesia;④ high dose group： Group Ⅳ（G4）.Blood samples were taken from the central venous line at the four time-points： T1（before ECC）/ T2（20 min after ECC beginning）/ T3（20 min after the cessation of ECC）/ T4（1 h after the end of operation）.Plasma levels of the cytokines including Interleukin-6（IL-6）,IL-8,IL-10 and Tumor necrosis factor-α（TNF-α） were analyzed by enzyme-linked immunosorbent assay（ELISA）.The patients＇ clinical outcomes were comparatively studied through the recording of clinical data.RESULTS ① Results of cytokine assay were as followed： plasma concentrations of TNF-α,Il-6,IL-8 and IL-10 increased gradually at T1,T2,T3 and T4,they reached a peak at T4.Cytokines were no significant differences at T1.TNF-α and IL-8 plasma levels were significantly（P0.05） lower in G3 than in the other three groups at T3 and T4.IL-6 was significantly lower in G3 than in others at T2,T3 and T4,its order from low to high was in G3,G2,G4 and G1.IL-10 was significantly higher in G3 than in others,its order from high to low was in G3,G4,G2 and G1.②Clinical outcomes： no significant differences were observed between the four groups.There were no incision infection and other important adverse complications.