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白细胞滤器在体外循环中对犬肾脏的影响
引用本文:杨亦彬,朱昭琼,郑洪,杜磊,黄颂敏. 白细胞滤器在体外循环中对犬肾脏的影响[J]. 中南大学学报(医学版), 2005, 30(3): 321-324
作者姓名:杨亦彬  朱昭琼  郑洪  杜磊  黄颂敏
作者单位:遵义医学院附属医院肾内科,贵州,遵义,563003;四川大学华西医院肾内科,成都,610041;遵义医学院附属医院肾内科,贵州,遵义,563003;四川大学华西医院麻醉科,成都,610041;四川大学华西医院肾内科,成都,610041
基金项目:国家自然科学基金青年基金(30400439)
摘    要:目的:探讨体外循环(CPB)中加用白细胞滤器(LDF-1)对犬肾脏的影响。方法:12只犬随机均分为对照组(不使用LDF-1)和实验组(静脉回流端置LDF-1)。全身麻醉建立CPB,并于CPB 10min后阻断升主动脉,经主动脉根部灌注St.Thomas液,70min后开放升主动脉并停机后观察2h,其中实验组于CPB 2min后开放LDF-1,过滤5min后停止。分别于不同时间点观察血白细胞数、L-选择素、IL-8、肾功能以及尿常规,同时行肾脏组织病理学检查。结果:实验组于CPB期间白细胞数下降55%~68%,CPB 10min时明显低于对照组(P<0.05);停CPB 2h后实验组L-选择素和IL-8亦明显低于对照组(P<0.05),而2组血尿素和肌酐无明显差异(P>0.05),但尿均出现明显红细胞;2组肾小管均呈现不同程度肿胀,对照组2例、实验组1例小管细胞空泡变性,肾小球无明显改变。结论:白细胞滤器能有效去除CPB中活化白细胞、减轻炎性反应,但单纯加用白细胞滤器不能发挥显著的肾脏保护作用,应注重CPB术后的肾脏保护。

关 键 词:体外循环  白细胞滤器  炎性反应  肾脏
文章编号:1672-7347(2005)03-0321-04
收稿时间:2005-01-26
修稿时间:2005-01-26

Effects of leukocyte depletion filter on canine kidney during cardiopulmonary bypass
YANG Yi-bin,ZHU Zhao-qiong,ZHENG Hong,DU Lei,HUANG Song-min. Effects of leukocyte depletion filter on canine kidney during cardiopulmonary bypass[J]. Journal of Central South University. Medical sciences, 2005, 30(3): 321-324
Authors:YANG Yi-bin  ZHU Zhao-qiong  ZHENG Hong  DU Lei  HUANG Song-min
Affiliation:1.Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China; 2. Department of Nephrology Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China;  3
.Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
Abstract:OBJECTIVE: To explore the effect of a reforming leukocyte depletion filter (LDF-1) on the functional and pathologic changes of canine kidney during cardiopulmonary bypass (CPB). METHODS: Twelve Mongolian dogs were randomly allocated into a control group (no LDF-1, n = 6) or a leukocyte-depleted filter group (LDF-1 placed in venous line, n = 6). CPB of the dogs anestheitized with sodium pentobarbitone at 25 mg/kg was set up. After 10 min of CPB, aorta was clamped and St. Thomas cardioplegic solution at 20 mg/kg was immediately injected into the root of aorta. The aortic cross-clamp was released and CPB was closed at 70 min. Dogs were observed for 2 h after weaning from CPB. LDF-1 was opened at 2 min and stoped at 7 min during initially running CPB in the LDF-1 group. Circulating leukocytes, plasma L-selectin, and plasma IL-8 were respectively counted before CPB, at 10 minutes, 40 min, and 75 min during CPB, the end of CPB, and 2 h after CPB. The urine analysis and renal pathology, which were obtained before CPB and 2 h after CPB, were observed. RESULTS: The number of leukocytes significantly decreased by 55% - 68% in the LDF-1 group compared with the baseline during CPB. The value at 10 min of CPB in the LDF-1 group was lower than that in the control group (P < 0.05). Plasma levels of L-selectin and IL-8 obviously increased in the 2 groups compared with the baseline during CPB, but both levels at 2 h after CPB in the LDF-1 group were lower than those in the control group (P <0. 05). No statistic difference was found in plasma levels of urea and creatinine, but hematuria was observed in the 2 groups at 2 hours after CPB. The pathologic changes of kidney, which was mainly renal tubule swelling accompanied partly with vacuolar degeneration, were similar under the light microscope in the 2 groups at 2 h after CPB. Obvious glomerular damage was not found. CONCLUSION: LDF-1 can effectively decrease leukocyte counts and the inflammatory reaction, but it can not bring about excellent protective effect on kidney during CPB when used alone. Attention to should be paid the renal protection in the postoperative CPB.
Keywords:cardiopulmonary bypass  leukocyte depletion filter  inflammatory reaction  kidney
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