体外循环状态下血液肿瘤坏死因子α、白细胞介素8、白细胞介素10水平的变化

Changes in serum tumor necrosis factor alpha,interleukin-8 and interleukin-10 levels under cardiopulmonary bypass

目的:心脏移植、心脏直视手术过程中的体外循环状态可导致各种炎症介质含量升高,强烈的炎症反应可引起肺损伤。肺开放策略可改善体外循环后肺损伤,观察肺开放策略对体外循环术后呼吸功能及肿瘤坏死因子α、白细胞介素8、白细胞介素10水平的影响。方法:①选择2005-10/2007-10于南通大学第二附属医院心胸外科在全麻、低温、体外循环下行心内直视手术的患者60例,所有患者对实验及治疗方案均知情同意。②将60例患者按随机数字表法分为常规机械通气组、早期肺开放组及晚期肺开放组,每组20例。早期肺开放组在气管插管后实施肺开放策略,晚期肺开放组到达ICU后30min实施肺开放策略。③应用酶联免疫吸附反应技术于术前、体外循环后及到达ICU后3,5,24,48h测定血清肿瘤坏死因子α、白细胞介素8、白细胞介素10水平。结果:患者60例全部进入结果分析。①体外循环后各组患者血清肿瘤坏死因子α、白细胞介素8、白细胞介素10水平均较术前显著升高(P<0.01)。②体外循环后早期肺开放组肿瘤坏死因子α水平上升幅度低于晚期肺开放、常规机械通气组(P<0.01);体外循环后早期肺开放组肿瘤坏死因子α水平逐渐下降,晚期肺开放、常规机械通气组肿瘤坏死因子α水平进一步上升。③血清白细胞介素8水平在期肺开放组、晚期肺开放组呈下降趋势,但常规机械通气组血清白细胞介素8水平各时点均高于术前(P<0.01)。④白细胞介素10水平只在早期肺开放组呈下降趋势。结论:肺开放策略可减少体外循环后炎性细胞因子的释放,从而减轻体外循环相关肺损伤,早期实施肺开放策略优于晚期实施。

AIM：Cardiopulmonary bypass （CPB） induces an increase in the levels of inflammatory mediators, resulting in lung injury during heart transplantation and open heart surgery. Open lung concept（OLC）improves lung injury after CPB. This study aimed to investigate the effects of OLC on pulmonary function and the levels of tumor necrosis factor-alpha （TNF-α）, interleukin-8 （IL-8） and IL-10 in patients after CPB. METHODS： ①Sixty patients undergoing open heart surgery under general anesthesia, low temperature and CPB were enrolled at Department of Cardiothoracic Surgery, Second Affiliated Hospital, Nantong University from October 2005 to October 2007. All patients singed informed consents. ②A total of 60 patients were divided at random into conventional mechanical ventilation （CMV） group, early open lung （EOL） group and late open lung （LOL） group with 20 in each group. Patients in the EOL group received OLC after tracheal intubation, whereas patients in the LOL group received OLC 30 minutes after arriving the intensive care unit （ICU）. ③Levels of TNF-α IL-8 and IL-10 were measured with enzyme-labeled immunosorbent assay （ELISA） before surgery, after CPB and 3, 5, 24, 48 hours after arriving ICU. RESULTS： A total of 60 patients were included in the final result. ①Levels of TNF-α, IL-8 and IL-10 were significantly higher in each group after CPB （P 〈 0.01）. ②The increasing degree of TNF-α levels was lower in the EOL group than in the LOL and CMV groups after CPB（P 〈 0.01）. TNF-α levels began to decrease in the EOL group, but increase in the LOL and CMV groups after CPB. ③IL-8 levels decreased in the EOL and LOL groups, but the IL-8 levels were significantly higher after CPB in the CMV group （P 〈 0.01）. ④IL-10 levels showed greater decreased tendency only in the EOL group. CONCLUSION： OLC ventilation leads to a decrease in lung injury after cardiac surgery by reducing inflammatory response. Early application of the OLC has a more pronounced effect compared to late application of this ventilation strategy.