常温与低温体外循环对机体免疫功能的影响

EFFECT OF NORMOTHERMIC AND HYPOTHERMIC CARDIOPULMONARY BYPASS ON IMMUNE SYSTEM

目的探讨常温及低温体外循环心脏直视手术对机体免疫功能的影响。方法40例心脏病患者,随机分为二组,常温组及低温组,每组20例。分别于术晨及转机末、术后1,4,7d抽取静脉血,测定血浆免疫球蛋白、补体C3、C4、T细胞亚群阳性率、白细胞介素-2(IL-2)和肿瘤坏死因子(TNF)。结果3种免疫球蛋白体外循环后均低于术前水平,至术后7d恢复正常。二组补体C3、C4水平在术中均有显著减低,至术后4d恢复正常。二组体外循环后CD8、CD4均低于术前,差异有统计学意义(P<0.05),至术后7d恢复正常,二组CD8均显著高于术前,CD4/CD8常温组大于低温组,至术后7d各项指标恢复。二组IL-2于术后1～4d,较术前均有显著下降,至术后7d恢复正常水平。转机末至术后4d与术前相比,低温组TNF有显著性升高,至术后7d基本恢复正常,而常温组TNF变化不显著。结论常温体外循环心脏直视手术对机体细胞免疫的影响显著轻于低温组,因而对术后机体的恢复及抗感染作用显著优于低温方法。

Objective To approach the effect of normothermic and hypothermic cardiopulmonary bypass during open heart surgery on immune system. Methods 40 patients with heart disease were divided into two groups randomly,normothermia group and hypothermia group,20 cases in each group. Venous blood samples were collected at points of preoperation,end of CPB,postoperative 1th,4th,7th days to examine the levels of IgA、IgM、IgG、C3、C4,positive ratio of T-cell,serum IL-2 and TNF. Results The results showed that IgA、IgM、IgG in both groups decreased significantly at 1th,4th day,and returned to normal at 7th day. C 3 and C 4 in both groups decreased significantly postoperatively and returned to normal at 4th day postoperatively.CD3,CD4 in both groups decreased significantly at day 1th,4th,and returned to normal at 7th day,and CD8 in both groups increased significantly at 1th,4th day,and returned to normal at 7th day,and CD3,CD4,CD4/CD8 ratio in hypothermic group was significantly lower than that in normothemia group.But CD8 in hypothermia group were significantly higher than that in normothermia group.IL-2 in both groups decreased significantly at 1th,4th day,and returned to normal at 7th day.IL-2 in hypothermic group was significantly lower that in normothermia group postoperatively;IL-2 in hypothermia group was significantly lower that in warm group postoperatively.TNF-α in hypothermia group was significantly higher postoperatively than that before operation.Whereas in normothermia group,there was no significant change before and after operation. Conclusion The effects of open heart surgery under normothermic CPB on immune system are less than those under hypothermic CPB, so it will be benefit for the recovery and anti-inflammation postoperatively.