浅低温心脏不停搏手术对减轻体外循环炎性反应的临床研究

Clinical study of beating heart surgery on alleviation of inflammatory response induced by cardiopulmonary bypass.

目的 评价浅低温心脏不停搏手术对减轻体外循环炎性反应的效果。方法 先天性心脏病患者 4 4例 ,随机分为观察组 (不停搏组 )和对照组 (停搏组 )。观察组在浅低温 (31～ 34℃ )体外循环、心脏跳动状态下手术 ;对照组在冷晶体停搏、中度低温 (2 8～ 30℃ )体外循环下手术。分别在术前 (T1)、体外循环结束后即刻 (T2 )、3h(T3 )、6h(T4)、2 4h(T5)采集血标本 ,检测血清中肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )、丙二醛 (MDA)含量。结果 体外循环结束后两组TNF α、IL 6、MDA含量均较术前明显升高 ;观察组IL 6含量在体外循环后各时点均低于对照组 (P <0 .0 1) ;观察组TNF α、MDA含量在体外循环后即刻、3h及 6h较对照组为低 (P <0 .0 5 ) ,在 2 4h两组无差异 (P >0 .0 5 )。结论 浅低温心脏不停搏手术可以减少细胞因子的释放 ,减轻体外循环炎性反应。

Objective To evaluate the effect of beating heart surgery in alleviating the systemic inflammatory response induced by cardiopulmonary bypass(CPB).Methods 44 patients with congenital heart disease were randomly divided into observation group(beating heart ) and control group.Observation group received surgery on beating heart with mild hypothermia(31 34 ℃) and control group received operation on arrested heart with moderate hypothermia(28 30 ℃)CPB.Blood samples were taken before operation(T 1),immediately after operation(T 2),3 h(T 3),6 h(T 4),24 h(T 5) for the detection of tumor necrosis factor α(TNF α),interleukin 6(IL 6) and malondiaehyde(MDA).Results TNF a,IL 6 and MDA in both groups were increased after operation.IL 6 in observation group was lower at each time point after operation than those in control group(P<0.01).TNF α and MDA in observation group were lower immediately after operation,3 h and 6 h than those in control group(P<0.05),but were not different at 24 h(P>0.05).Conclusion Beating heart surgery with mild hypothermia can alleviate the systemic inflammatory response and decrease the release of cytokine.