米力农对风心病瓣膜置换患者炎性反应的影响

Alterations of the cytokine network and the influence of milrinone on it in the patients undergoing valve replacement surgery

目的探讨风心病瓣膜置换术患者白介素-6、-8、-10(IL-6、-8、-10)与炎性细胞的变化及米力农对其影响。方法20例心功能Ⅱ～Ⅳ级瓣膜置换术患者，随机分为米力农组和对照组。米力农组10min内用负荷剂量米力农30μg／kg、继以0．5μg·kg^-1·min^-1持续静脉输注；对照组以相同速度推注生理盐水。分别于麻醉诱导前、诱导后30min、主A开放后10min、主A阻断后30min，主A开放后10min、主A开放后30min、体外循环后30min、体外循环后8h、术后24h及术后72h采取混合静脉血7ml。其中0．5ml测白细胞、中性粒细胞、淋巴细胞、血小板，剩余全血以3000r／min离心lOmin后留取上清液，用酶联免疫吸附反应技术测定细胞因子IL-6、IL-8及IL-10。结果米力农组ICU机械通气时间显著少于对照组(P<0．05)；两组白细胞、中性粒细胞、IL-6、IL-8在主A开放后30min至术后72h，IL-10在主A阻断后30min至术后72h时点显著升高，各参数的峰值都出现在体外循环后30rain，但米力农组同时点的IL-6水平显著低于对照组，而IL-10则显著高于对照组。结论①风心病瓣膜置换术患者可出现较强而短暂的炎性反应，该反应于体外循环后30min达到高峰，并持续至术后72h；②米力农对体外循环下心脏手术所致的炎性反应具有平抑作用．可缩短ICU的机械通气时间。

Objective To evaluate the alterations of the cytokine network,WBC,PMN,platelet(PLT) and the effects of milrinone on the inflammatory response in the patients undergoing valve replacement.Methods Twenty patients,scheduled for valve replacement were randomly divided into 2 groups:group milrinone receiving milrinone [in a 30μg/kg bolus dose progressively in 10 min,followed by a continuous infusion of 0.5μg/(kg·min)]and group saline receiving same volume of saline.The mixed venous blood samples(7ml) were obtained from the pulmonary artery before induction of anesthesia(T 1),30min,after anesthesia(T 2),30min after the cross clamping of aorta(T 3),10min and 30min after the removal of the aorta clamping(T 4,T 5),30min and 8 hours after CPB(T 6,T 7),24hours and 72 hours after operation(T 8,T 9).WBC,PMN,LYM and PLT were determined by the multifunctional blood cell analysor.Pro inflammatory cytokines(IL-6,IL-8)and anti inflammatory cytokine(IL-10) were determined by enzyme linked immunosorbent assay(ELISA).Results (1) No singnificant differences were found between the groups in age,sex,height,body weight and body surface area(BSA).All patients were separated successfully from CPB.Except for 1 patient of the group milrinone who died of abrupt ventricular fibrillation 3 days after operation,all patients left the hospital without major postoperative complications,and they have shorter periods of mechanical ventilation than group saline.(2)The levels of WBC,PMN,IL-6 and IL-8 at the intervals from T 5 to T 9 were significantly greater than the baselines at point T 1,meanwhile the levels of anti inflammatory cytokine IL-10 were increased significantly.They all peaked at the point of T 6.(3)Compared with group saline,the levels of IL-6 is decreased in group milrinone at the intervals from T 5 to T 9.While IL-10 is increased(P<0.05).IL-8 has no significant difference.Conclusions (1) Valve-replacement surgery and CPB elicited a marked,transient and almost simultaneous pro inflammatory and anti inflammatory reaction.Peaks of the reaction apparently initiated at the point T 6.(2) Perioperative administration of low dose milrinone may have anti inflammatory properties and can shorten mechanical ventilation periods.