围术期容量治疗策略对心肺转流后急性炎症反应的影响

Influence of different volume replacement strategies on systemic inflammatory response syndrome after cardiopulmonary bypass

目的对比羟乙基淀粉130/0.4(万汶)与琥珀酰明胶(佳乐施)对心肺转流(CPB)后急性炎症反应的影响。方法23例择期CPB下实施冠状动脉搭桥手术(CABG)的患者随机分为两组:Ⅰ组患者的CPB预充液及术中、术后48h容量治疗选用羟乙基淀粉;Ⅱ组选用琥珀酰明胶。观察两组患者的容量治疗策略和急性炎症反应的发生情况,并分别于麻醉诱导后、停机时、术后2、24、48h采动脉血检测C反应蛋白(CRP)、白细胞介素-6(IL-6)、P选择素(P-selectin)和细胞间黏附因子(ICAM-1)含量。结果两组患者的急性炎症反应发生情况相似;术后24、48h两组CRP显著升高(P<0.05),但术后48hⅠ组比Ⅱ组升高更为显著(P<0.05);术后24、48h两组ICAM-1均较麻醉诱导后升高(P<0.05),而术后48hⅡ组比Ⅰ组升高更为显著(P<0.05)。术后48hⅠ组P-Selectin、IL-6显著升高(P<0.05),组间差异无统计学意义。结论围术期应用羟乙基淀粉有利于激活急性期反应蛋白,并减轻内皮损伤维持内皮稳定性,从而减轻CABG后急性炎症反应。

Objective To compare the effect of hydroxyethylstarch（HES 130/0. 4）on systemic inflammatory response syndrome（SIRS）after cardiopulmonary bypass（CPB）with gelofusine（MFG） in patients undergoing coronary artery bypass grafting（CABG）. Methods Twenty-three patients scheduled for selective CABG were randomized to receive either HES 130/0.4 （n= 12,group Ⅰ ） or MFG （group Ⅱ ,n= 11） as prime solution and volume replacement. Fluid therapy was given perioperatively and continued for 48 h after operation. The incidence of SIRS was recorded. The serum concentrations of C-reactive protein（CRP）, interleukin （IL）-6, P-selectin and intercellular adhesion molecule-1 （ICAM-1） were measured after induction of anesthesia,at the end of CPB,as well as 2 h,24 h and 48 h after the end of CPB for both groups. Results Biometric and perioperative data of two groups were similar. There was no marked difference in the number of patients suffering from SIRS. At 24 h and 48 h after CPB, CRP levels were increased in two groups, but the difference was statistically significant only at 48 h between the two groups （P〈0.05）. The concentration of P-selection rose in two groups at the end of CPB and continued to increase during the first 2 postoperative days without significant difference between the two groups. Serum concentrations of ICAM-1 were significantly higher in two groups at 24 h and 48 h after the end of CPB than those after induction,particularly at 48 h in group Ⅱ. Plasma IL-6 levels were elevated above the preoperative levels and there was not statistically significant between the two groups. Conclusion Compared to MFG,volume replacement with HES 130/ 0.4 may reduce the inflammatory response in patients undergoing CABG surgery, resulting from reduced endothelial activation and endothelial damage induced by HES 130/0.4.