心肺转流下不停跳心脏手术对血浆C反应蛋白及细胞因子水平的影响

Effects of cardiopulmonary bypass with a beating heart on C-reactive protein (CRP) and cytokines in serum in patients undergoing heart operation

目的 比较心肺转流(CPB)下不停跳和停跳心脏手术对患者血浆中C反应蛋白 (CRP)及促炎性因子肿瘤坏死因子α(TNF α)、白细胞介素 8(IL 8)、白细胞介素 10(IL 10)水平的影 响。方法 择期心内直视手术患者20例分为两组:CPB下心脏不停跳组(A组)和CPB下心脏停跳 组(B组);每组各10例。分别于全麻诱导前(基础,T0)、主动脉开放后5min(T1)、CPB停机后5min (T2)、术毕(T3)、术后24h(T4)、术后48h(T5)抽取患者中心静脉血,放免法定量测定TNF α、CRP、 IL 8和IL 10的血浆水平。结果 A组和B组相比较,CRP在T4～T5、IL 10在T3～T5增加显著, 而IL 8在T2～T4降低明显,差异有显著意义(P<0.05)。和T0相比较,A组中CRP在T3～T5、IL 8在T3和IL 10在T2～T5增加显著;而B组中,CRP在T4～T5、IL 8在T2～T4和IL 10在T3～ T5增加明显,差异有显著意义(P<0.05)。结论 心内直视手术时采用CPB下心脏不停跳技术,可 在围术期减轻患者机体炎性反应方面起积极作用。

Objective To evaluate the systemic inflammatory response to CPB in patients undergoing heart surgery with a beating heart or an arresting one. Methods TNF-α, CRP, IL-8, and IL-10 were analyzed with radio immunoassay (RIA) method just prior to induction of anesthesia (baseline, T 0), 5 min after aortic cross-clamp release (T 1), 5 min after weaning from CPB (end-CPB, T 2), on completion of surgery (T 3), 24 hours (T 4) and 48 hours after the operation (T 5) in 10 patients, submitted to beating heart group (group A), and in 10 with arresting one (group B). Results In group A vs group B a significant increase of CRP was detected at T 4, T 5and IL-10 at T 3-T 5 respectively. At T 2-T 4 in group B, IL-8 levels were higher than the one in group A significantly. Compared with T 0, CRP was higher at T 3-T 5, IL-8 at T 3 and IL-10 at T 2-T 5 in group A and CRP at T 4-T 5, IL-8 at T 2-T 4 and IL-10 at T 3-T 5 were higher in group B(P<0.05).Conclusions In patients undergoing CPB with a beating heart, CRP and cytokine production seems to be an adaptive response to attenuate the CPB-induced inflammatory response.