常温及低温体外循环对机体免疫功能影响的对比研究

Comparative study of influence on immunity with normothermic and hypothermic cardiopulmonary bypass during open heart surgery.

目的探讨常温体外循环对机体免疫功能的影响,以寻找减轻免疫损伤的方法,提高手术效果,减少术后并发症发生。方法选择先天性或风湿性心脏病患者40例,随机分为两组,常温组及低温组,每组20例。分别于术晨、转机末及术后1、4、7、14天抽取静脉血标本,测定血浆IgA、IgM、IgG、TNF-α、IL-2、CD3、CD4、C3、C4含量。结果与术前相比,手术后IgA、IgG、IgM、IL-2、C3、C4、CD3、CD4均有不同程度地降低,TNF-α、CD8均有不同程度地升高;组间相比,两组术前各项指标相似,术后IgA、IgM、IgG、IL-2、CD3、CD4、C3、C4均有一个以上的时间点高于低温组,TNF-α低于低温组,CD8两组相似,无显著性差异。结论常温体外循环心脏直视手术对免疫系统的影响较低温方法轻;常温体外循环对补体及细胞因子的影响显著轻于低温方法。因此,常温方法有利于术后机体的恢复及抗感染作用。

Objective To compare the detrimental influence on immunity function, cytokines and complements with normothermic and hypothermic cardiopulmonary bypass during open heart surgery. Methods 40 patients with congenital or rheumatic heart disease were randomized to receive the two strategies： normothermic cardiopulmonary bypass （CPB） （study group） and hypothermic CPB （control group）, 20 cases in each group. Venous blood samples were collected at each time points of preoperation, end of CPB, day 1,4,？,14 postoperatively to examine the plasma level of IL-2, TNF-α, C3, CA, IgG, IgM, IgA, CD3, CD4, CDS. Results Compared with preoperation, the concentrations of IgA, IgG, IgM, C3, CA, CD3, CD4, IL- 2 decreased at a certain extent postoperatively; TNF-α, CD8 increased at some extent postoperatively. There was no significantly difference between groups preoperatively. The concentrations IgA, IgG, IgM, C3, CA, CD3, CD4 and IL-2 in study group were significantly higher than those in control group, postoperatively. The concentration of plasma TNF-α in study group was significantly lower than that in control group, postoperatively. There was no significant difference of CD8 between the two groups. Conclusion The detrimental influence of open heart surgery with normothermic CPB on humoral and cellular immunity function, cytokines and complements is less than that with hypothermic CPB, so normothermic CPB is beneficial for the postoperative recovey and anti- inflammation function.