冷温血停搏液联合灌注对瓣膜置换术中炎性细胞因子和自由基的影响

Effects of cardioplegia with cold and warm blood on proinflammatory cytokines and oxygen free radicals in valvular replacement patients

目的 评价冷温血停搏液联合灌注在瓣膜置换术中对血浆促炎性细胞因子和自由基代谢水平的影响 ,探讨更有效的心肌保护方法。方法 将 30例瓣膜病病人随机分为两组 :温血组 (A组 ,n =15 ) ,采用温血诱导心脏停搏、冷血维持与终末温血灌注心肌保护方法 ;冷血组 (B组 ,n =15 ) ,采用冷氧合血停搏液进行心肌保护。分别于心肺转流 (CPB)前 (T1)、CPB 30min(T2 )、CPB结束后30min(T3 )、4h(T4)、2 4h(T5)测定血浆白细胞介素 6 (IL 6 )、IL 8和MDA浓度及SOD活性。结果B组IL 6于T2 即升高 ,持续至T5;A组无明显变化 ,于T3 明显低于B组 (P <0 0 5 )。B组IL 8于T2升高 (P <0 0 1) ,至T3 达峰值 (P <0 0 1) ,于T5下降至基础值水平 ;A组在T3 ～T4较基础值明显升高 (P <0 0 5 ) ,于T2 ～T4均显著低于B组 (P <0 0 5 )。两组MDA均在T2 升高 ,持续至T4,但A组于T3 、T4显著低于B组 (P <0 0 5 )。B组SOD活性自T2 开始降低 ,持续至T4(P <0 0 1) ;A组无明显变化 ,且在T3 与B组比较有显著性差异 (P <0 0 5 )。结论 冷温血停搏液联合灌注对瓣膜病病人的心肌再灌注损伤的抑制效应优于冷血心脏停搏液。

Objective To investigate the efficacy of cold and warm blood cardioplegic solution on proinflammatory cytokines and oxygen free radicals in valvular replacement and find the effective method of myocardial preservation.Methods Thirty patients with valvular heart disease were randomly divided into two groups.Group A(n=15)was given cold blood cardioplegia,followed by warm blood cardioplegia immediately after aortic clamping and just before aortic unclamping.Cold blood cardioplegia was used throughout CPB in group B(n=15).Blood samples were taken before CPB(T 1),at 30 min after start of CPB(T 2)and 30 min(T 3),4 h(T 4)and 24 h(T 5)after termination of CPB for the measurements of plasma IL-6,IL-8,MDA concentration and SOD activity.Results IL-6 level was lower at T 3 in group A than that in group B.IL-8 level at T 2-T 4 was lower in group A than that in group B(P<0.05-0.01).The plasma level of MDA incresed after CPB in both groups,but plasma level of MDA at T 3-T 4 was significantly lower in group A than that in group B(P<0.05-0.01).SOD activity at T 3 was remarkably higher in group A than that in group B(P<0.01).Conclusion Warm blood cardioplegic solution is more effective in reducing myocardial reperfusion injury than cold blood cardioplegic solution in patients with valvular heart disease.