体外循环平衡超滤对肿瘤坏死因子表达的影响

Effect of zero-balanced ultrafiltration on expresion of TNF-α

目的:评估体外循环中采用零平衡超滤对肿瘤坏死因子α(TNF-α)的影响。方法:二尖瓣替换术或二尖瓣与主动脉瓣联合替换术的患者40例,每组20例;对照组不做任何形式的超滤;试验组体外循环中行零平衡超滤,超滤量约60m l/kg,平均3417m l/例。分别在诱导后、体外循环(CPB)结束后2h、24h和48h测定肿瘤坏死因子α(TNF-α)的浓度。结果:两组均无死亡,对照组二次体外循环1例;两组间TNF-α浓度在诱导后、CPB结束后48h没有显著性差异,而在CPB结束后2h,试验组要低于对照组(P<0.05);CPB结束后24h,试验组也明显低于对照组(P<0.01)。结论:体外循环中采用零平衡超滤可降低患者血中TNF-α的浓度,能有效预防体外循环术后全身炎症反应。

Objective：To assess the effect of zero-balanced uitrafiltration on the level of TNF-α, Methods：From May 2004 to Feb 2003, 40 mitral valve disease or double valve cases underwent valve replacement in shanghai chest hospital randomized enrolled in this study, randomised separated into two groups, 20 cases each. Control group did not use any means of ultrafiltration. Trial group underwent zero-balanced ultrafiltration , Ultrafiltrated fluid was 60ml/kg each case, mean 3417ml. TNF-α concentration was detected at follow point： after induction of anesthesia, post-CPB 2hour, 24 hour, 48 hour, Results ：There was no death in two groups, In control group,there was 1 patient reintubation. Trial group respiration support time was shorter than that of control group（P〈0. 05）. In post-CPB 2hour, trial group TNF-α was lower（P〈0.05）. In post-CPB 24hour, trial group TNF-α was also lower（P〈0. 01）. Conclusion：Zero-balanced ultrafiltration may effectively protect systemic inflammatory response after CPB.