米力农对心肺转流促炎细胞因子反应及心肌损伤的影响

Effects of milrinone on cardiopulmonary bypass-induced proinflammatory cytokine response and myocardial injury

目的探讨米力农对心肺转流(CPB)诱发的促炎细胞因子反应及心肌损伤的影响。方法24例择期瓣膜替换术病人,随机分成米力农组(M组)和对照组(C组),每组12例。麻醉诱导开始前,M组给予米力农30μg/kg负荷量静注,继以0.5μg·kg-1·min-1持续静脉输注;C组以相同速度输注等量生理盐水。分别于术前(T1)、CPB60min(T2)、CPB结束后2h(T3)、4h(T4)及24h(T5)各时间点测定动脉血中下列各项指标:肿瘤坏死因子α(TNFα)、白细胞介素6(IL6)、白细胞介素8(IL8)、血浆过氧化脂质(LPO)、心肌肌酸激酶同工酶(CKMB)。结果与T1比较,其余各时点两组TNFα、IL6、IL8、LPO、CKMB均明显升高(P<0.05或P<0.01),但M组升高明显低于C组(P<0.05)。结论米力农能有效抑制CPB诱发的促炎细胞因子反应和心肌损伤。

Objective To investigate the effects of milrinone on cardiopulmonary bypass- induced proinflammatory cytokine response and myocardial injury. Methods Twenty-four adult patients undergoing cardiac valve replacement were randomly divided into control group（C） and milrinone group（M） with 12 cases each. The patients in group M were given milrinone in a dose of 30μg/kg bolus, followed by a continuous infusion of 0. 5μg·kg^-1·min^-1 before anesthesia induction, and those in group C the same volume of saline was used instead of milrinone. Blood samples were taken from radial artery before operation（T1 ）, at 60 rain of CPB（T2）and at 2, 4 and 24 h after wea- ning from CPB （T3, T4, T5）for determination of plasma tumor necrosis（TNF）a, interleukin （IL）-6, and IL-8, lipid peroxide （LPO） and creatine kinase isoenzyme（CK-MB） activity. Results The age, body weight, aortic cross-clamp time, CPB time, duration of operation were comparable between two groups. In both groups, TNF-α, IL-6, IL-8, LPO concentrations and CK-MB activity increased significantly from T2 to T5 as compared with the baseline values （P〈0.05 or P〈0.01） ,but the levels of TNF-α, IL-6, IL-8, LPO and CK-MB activity were significantly lower in group M than those in group C （P〈0.05）. Conclusion Milrinone is effective in reducing CPB-induced proinflammatory cytokine response and myocardial injury.