心肺转流心瓣膜手术时肺静脉和主动脉窦血液中炎性反应介质差异的研究

Differences of inflammatory mediators in between pulmonary vain and aortic sinus in patients undergoing cardiac valve replacement under cardiopulmonary bypass

目的比较心肺转流(CPB)前和主动脉开放后10 min时瓣膜置换术患者肺静脉(PV)和主动脉窦(AS)中P-选择素(CD62P)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)血浆水平变化.方法12例择期行CPB心瓣膜置换手术的患者,ASAⅢ～Ⅳ级,分别于CPB前、主动脉开放后10 min抽取患者PV(T1、T3)和AS(T2、T4)血,采用酶联免疫法定量测定CD62P的血浆水平,采用放射免疫方法定量测定IL-8和IL-10血浆水平.结果CPB前PV和AS中CD62P、IL-8和IL-10值相比差异无显著性.主动脉开放后10 min时,CD62P和IL-8的PV值及AS值均较各自CPB前显著上升(P＜0.05),IL-10的PV值较CPB前显著上升(P＜0.05),而AS值虽较CPB前上升但差异无显著性.主动脉开放后10 min,CD62P、IL-8和IL-10的AS值分别和各自的PV值相比均有显著下降(P＜0.05).结论CPB心瓣膜置换术时左心内膜未见大量炎性反应介质释放.

Objective To compare the differences of inflammatory mediators in between pulmonary vain （PV） and aortic sinus （AS） in patients undergoing replacement of cardiac valve under cardiopulmonary bypass （CPB）. Methods Twelve ASA Ⅲ-Ⅳ adult patients undergoing elective cardiac valve replacement under CPB were enrolled in this study. Blood was simultaneously drawn by surgeons from the PV（T1 ） and AS（T2 ） before CPB （after opening of the pericardium）, and at 10 min of reperfusion after release of aortic cross-clamp, which were named T3 and T4 respectively. Concentrations of P-selectin（CD62P） were measured using a quantitative sandwich enzyme linked-immunosorbent assay （ELISA）. The plasma concentrations of IL-8 and IL-10 were measured by radioimmunoassay （RIA）. Results There were no significant differences in plasma concentrations of CD62P, IL-8 and IL-10 between PV and AS before CPB. At 10 min of reperfusion, the CD62P and IL-8 tended to be higher in PV and AS compared with those before CPB （P〈0.05）, and IL-10 of PV increased significantly compared with that of AS. At 10 min of reperfusion, the concentrations of CD62P, IL-8 and IL-10 were lower in AS than those in PV （P〈0.05）, Conclusion There were no inflammatory cytokines found in the left endocardium in patients undergoing cardiac valve replacement under CPB.