体外循环中滤过白细胞对TNF-α和肺氧合功能的影响

Influence of leukocyte depletion on lung oxygenation function and plasma TNF-α level during extracorporeal circulation

目的:研究体外循环(CPB)中滤过白细胞对TNF-α和肺氧合功能的影响。方法:随机选取20例双瓣置换术患者,根据是否滤过白细胞分为两组:对照组和白细胞滤过组。观察从麻醉诱导至主动脉开放后24h内不同时点红细胞压积、白细胞、血小板计数和TNF-α浓度;根据动脉血气结果计算肺泡-动脉血氧分压差(A-aDO2)和氧合指数(PaO2/FiO2)。结果:CPB开始后两组TNF-α均增高,滤过组在开升主动脉后5min、1h低于对照组(P<0.05与P<0.01)。两组白细胞、中性粒细胞计数于CPB30min时处于最低值,复温时已开始上升,升高幅度对照组较滤过组大(P<0.05或P<0.01)。血小板计数从体外循环开始后均下降,差异不明显。滤过组PaO2/FiO2在CPB后2h和12h高于对照组(P<0.01与P<0.05),A-aDO2低于对照组(P<0.01)。结论:白细胞在体外循环的心肺再灌注损伤中起一定的作用,滤过再灌注期的白细胞减少了白细胞在心肺中的积聚,改善了肺氧合功能。

Objective: To evaluate the efficaecy of leukocyte-depletion on lung oxygen- ation function and TNF-α level in cardiac surgery. Methods:Twenty patients undergoing elective double valve replacement were included in this study. The patients were allocated into a leukocyte depletion group(group LD) and a control group(group C). Blood samples were collected for determination of total leukocyte count, neutrophil count, pletelet count, HCT and TNF-αlevel. FiO 2 , PaO 2 and PaCO 2 were measured. Oxygenation index(PaO 2 /FiO 2 )and A-aDO 2 were calculated. Results: TNF-αwas higher in group C than that in group LD at five minutes and 1h after aortic declamping. The total WBC and neutrophil counts were significant higher after aortic declamping in group C (P<0.05 or P<0.01), PaO 2 /FiO 2 was lower and A-aDO2was higher than that in group LD.Conclusion: Leukocyte plays a definite role in injury of cardiopulmonary reperfusion during extracorporeal circulation. The leukocytes in the stage of the filtrated reperfusion attenuates the accumulation in the heart and lung, and improve oxygenation function of lung.