体外循环中搏动灌注和非搏动灌注对细胞因子影响的比较

目的评价体外循环(CPB)时应用搏动灌注(PP)和非搏动灌注(NPP)对患者术后细胞因子的影响。方法拟行CPB的患者60例,采用随机、双盲的方法分为搏动灌注组(PP组)和非搏动灌注组(NPP组),每组30例。PP组在体外循环机后串联双搏动式心肺辅助装置,在主动脉阻断期间采用搏动灌注。NPP组全程均采用非搏动灌注。两组灌流量控制在2.3～2.8 L/min.m2。分别于术前(T1);CPB期间0.5(T2)、1 h(T3);CPB后2(T4)、4(T5)、8(T6)、24 h(T7)抽取桡动脉血,测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-8和IL-10浓度。结果两组患者一般资料无统计学差异。与T1比较,两组TNF-α、IL-8、IL-10血清浓度在T2～T7均升高(P<0.01)。与NPP组比较,PP组TNF-α血清浓度在T2～T6降低(P<0.05);IL-8血清浓度在T3～T6降低(P<0.05);IL-10血清浓度在T3～T6升高(P<0.05)。结论 PP能有效地抑制TNF-α、IL-8的释放,并使IL-10的释放明显上调,可在一定程度上降低全身炎症反应,减轻组织脏器损伤。

The comparison of impacts of pulsatile and non-pulsatile perfusion on cytokines in patients undergoing cardiopulmonary bypass

Objective To evaluate the clinical effects of pulsatile perfusion(PP) and non-pulsatile perfusion(NPP) on cytokines in patients undergoing cardiopulmonary bypass(CPB).Methods Sixty low risk patients undergoing CPB were divided in a double-blind and randomized fashion into 2 groups(n=30,each group):NPP group and PP group.In PP group,the pulsatile flow was applied during the period of aortic cross-clamping.In NPP group,the non-pulsatile flow was applied during CPB.In both groups,pump flow was set to 2.3-2.8 L/min·m2.Blood samples were taken from radial artery for determination the concentration of plasmic tumor necrosis factor-alpha(TNF-α),interleukin-8(IL-8) and interleukin-10(IL-10) before CPB(T1),during CPB 0.5 h(T2),1 h(T3),and 2 h(T4),4 h(T5),8 h(T6),24 h(T7) after cessation of CPB.All of these cytokines were estimated by enzyme-linked immunoadsordent assay(ELISA).Result The two groups were compared in respects of age,sex,stature,body weight,ejection fraction,accompanying diseases,operation type,the caliber of the arterial cannula,duration of CPB and aortic cross-clamping time.Plasma concentrations of TNF-α,IL-8 and IL-10 were significantly increased at T2-T7 as compared to the baseline values at T1 in both groups(P<0.01);the plasma concentrations of TNF-α at T2-T6 and IL-8 at T3-T6 were significantly lower in PP group(P<0.05);the plasma concentrations of IL-10 at T3-T6 were significantly higher in PP group(P<0.05).Conclusion Pulsatile perfusion can effectively attenuate CPB induced acute systemic inflammatory response and reduce injury of tissues and organs.