机械通气对小儿体外循环术后IL-6 IL-10及TNF-α的影响

目的：体外循环（CPB）术造成全身炎症因子水平升高，机械通气可能对其水平有一定影响。该文探讨不同机械通气模式对小儿CPB术后炎症因子的影响，为临床治疗提供参考。方法：60例CPB术后小儿随机分为A组和B组，每组30例，A组术后接受高潮气量-低PEEP机械通气，B组接受低潮气量-高PEEP机械通气，比较两组血浆中IL-6，IL-10及TNF-α的水平在不同时间点的差异。结果：两组患儿炎症因子在CPB结束时显著增高，在术后1 h达到峰值。术后1 h和6 h，A组炎症因子水平均高于B组。结论：不同的机械通气模式对CPB术后全身炎症因子水平有一定影响，低潮气量-高PEEP模式显著降低炎症因子水平。

Effects of mechanical ventilation on plasma IL-6, IL-10 and TNF-α in children after cardiopulmonary bypass

OBJECTIVE: To study the effects of different models of mechanical ventilation on inflammatory cytokines, IL-6, IL-10 and TNF-α, in children after cardiopulmonary bypass (CPB). METHODS: Sixty patients who underwent CPB were randomly divided into group A and group B. After CPB, group A was ventilated with high tidal volume (VT, 10-12 mL/kg) /low positive end-expiratory pressure (PEEP, 3-5 cm H2O), while group B was ventilated with low VT (6-8 mL/kg) /high PEEP (6-9 cm H2O). Plasma levels of IL-6, IL-10and TNF-α were measured before operation, at the end of the operation, and 1 and 6 hrs after operation. RESULTS: Serum levels of IL-6, IL-10 and TNF-α in both groups increased significantly at the end of the operation and reached a peak by 1 hr after operation. Group B showed lower serum levels of IL-6, IL-10 and TNF-α than group A 1 and 6 hrs after operation. CONCLUSIONS: Mechanical ventilation with low VT /high PEEP may more effectively inhibit the release of inflammatory cytokines than that with high VT /low PEEP in children after CPB.