新型白细胞滤器LD-1对体外循环中红细胞的保护作用

The Protective Effects of a New Type of Leukocyte-depletion Filter-1 on Red Blood Cells During Cardiopulmonary Bypass

目的研究一种新型白细胞滤器LD-1在体外循环(CPB)中对红细胞的保护作用。方法将25～30kg蒙古犬12只按随机数字表法分为对照组和LD-1过滤组(LD组),每组6只。对照组不使用白细胞滤器;LD组将白细胞滤器LD-1安装于CPB的静脉回流端,在CPB开始2min后打开滤器,过滤5min。分别于CPB前、CPB10min、40min、75min、停CPB和CPB后2h取静脉血测定白细胞(WBC)数量、血浆丙二醛(MDA)、超氧化物歧化酶(SOD)和游离血红蛋白(FHB)水平,并测定红细胞脆性。结果在CPB中各时间点LD组WBC数量均显著低于CPB前(P<0.01),且明显低于对照组(P<0.05);对照组血浆SOD水平在CPB75min后显著降低,而LD组血浆SOD水平在CPB75min、停CPB及CPB后2h均显著高于对照组(P<0.05,0.01);在CPB后各时间点LD组MDA水平均低于对照组,但无统计学意义;对照组在停CPB和CPB后2h,红细胞开始溶血和完全溶血所需的氯化钠浓度明显高于LD组(P<0.05);CPB后两组血浆FHB浓度均升高(P<0.01),但LD组在CPB40min后各时点均显著低于对照组(P<0.05)。结论新型白细胞滤器LD-1在CPB中能有效去除白细胞,保存血浆的抗氧化能力,抑制氧自由基对红细胞的破坏。

Objective To assess the protective effects of a new type of leukocyte-depletion filter-1 (LD-1) on red blood cells during cardiopulmonary bypass(CPB). Methods Twelve Mongolian dogs, weight range 25-30kg, were divided into control group and leukocyte depletion group (LD group) with random number table, LD group (n=6) had our new type of leukocyte depletion filter-1 placed in venous line which was used within the first 5 minutes after onset of CPB. The control group (n=6) had no leukocyte depletion filter installed in the circuit. CPB was set up by cannulated with a venous cannula through the right atrium and with an aortic cannula after median sternotomy. Aorta was clamped at 10 minutes of CPB and released at 70 minutes of CPB. Dogs were observed for 2 hours after weaning from CPB. Blood samples were collected prior to, at 10, 40, 75 minutes, end of and 2 hours after CPB to determine circulating leukocytes, erythrocyte fragility and plasma levels of malondialdehyde(MDA), superoxide dismutase(SOD) and free hemoglobin(FHB). Results Leukocyte numbers were significantly reduced in LD group during CPB(P<0.01), and lower than those in control group (P<0.05). Plasma levels of SOD dropped after 75 minutes of CPB in control group, but those kept normal in LD group, and higher than those in control group at 2 hours after CPB (P<0.05, 0.01). Serum MDA and FHB levels increased sharply in two groups (P<0.01), but were lower in LD group than those in control group. The concentrations of NaCl when starting and complete hemolysis were also lower in LD group than those in control group at end of and 2 hours after CPB. Conclusion The new type of LD-1 used in venous line only 5 minutes after onset of CPB can decrease leukocyte counts, and reduce erythrocyte injury effectively.