白细胞滤器在体外循环中作用的研究

Study on Leukocyte Depletion during Cardiopulmonary Bypass

目的：研究白细胞滤过器（ＬＤＦ）在体外循环（ＣＰＢ）手术中消除心肌再灌注损伤的作用，探 讨ＬＤＦ在ＣＰＢ中心肌保护的效果。方法：随机选择２０例体外循环手术的病人，心肌保护方法采用 中度低温含血心肌保护液持续顺行灌注，随机选择１０例（实验组）于含血心肌保护液通路加用 ＬＤＦ，测定滤过前后血细胞的变化、主动脉阻断前后全组血清乳酸脱氢酶（ＬＤＨ）、血浆丙二醛 （ＭＤＡ）、心肌超微结构的变化；应用持续左心功能（ＣＣＯ）监测术后血流动力学的变化。结果：滤过 后白细胞滤除率为０．９１±０．０５（Ｐ＜０．０５），红细胞滤除率０．０８±０．０３（Ｐ＞０．０５），血小板滤除率０．８８ ±０．０６（Ｐ＜０．０５）。对照组ＬＤＨ的变化由阻断前的１０３±２４Ｕ／Ｌ升至主动脉开放后的３６５±８９Ｕ／Ｌ （Ｐ＜０．０１），实验组由１１０±３４Ｕ／Ｌ升至１９９±３５Ｕ／Ｌ（Ｐ＜０．０５），实验组较对照组产量低（Ｐ＜０．０５）。 ＭＤＡ的变化对照组由５．５５±０．３４ｎｍｏｌ／ｍｌ增至１７．３１±０．５８ｎｍｏｌ／ｍｌ（Ｐ＜０．０１），实验组由４．９８±０． ５６ｎｍｏｌ／ｍｌ增至７．９８±０．２１ｎｍｏｌ／ｍｌ（Ｐ＜０．０５）。

Objective: To elucidate the protective effect of leukocyte depletion on myocardium during heart surgery with cardiopulmonary bypass (CPB) in the settings of myocardial reperfusion injury. Method: Twenty patients undergoing CPB, with continous infusion of blood cardioplegia, were randomized into experimental group( n = 10, Group I) with the use of leukocyte depletion filter (LDF) on the bypass circut, and the control group ( n = 10, Group II). The blood cell account before and after the filtration were measured, and the levels of serum LDF and MDA as well as ultrastructural changes of the myocardium were determined before and after aortic cross - clamped ( ACC). Continuous cardiac output (CCO) monitoring were applied to evaluate the postoperative hemodynamics. Results: It showed the production of LDH and MDA was lower in Group I. The myomeres and mitochondrial structures were relatively well preserved whereas the electron density were reduced more obviously in Group II during reperfusion period. The left ventricular functions were beter preserved in Group I. Conclusions: LDF can significantly attenuate myocardial reperfusion injury and have protective effect on myocardium in promoting recovery of left ventricular functions.