体外循环对全身炎症反应的影响

Effect of cardiopulmonary bypass(CPB) on systemic inflammatory response(SIR)

目的探讨体外循环(CPB)对全身炎症反应(SIR)的影响。方法选择健康杂种犬12只,随机分为自体肺组(利用杂种犬自体肺作为氧合器)和人工肺组(常规体外循环,利用鼓泡肺作为氧合器)。两组采用相同的心肌保护、心脏停跳方法(冷晶体停跳液),CBP持续1小时,于CPB前、CPB开始30分钟、停机后5、60分钟、2、4小时取血标本,用ELSISA法测定血浆中白介素-6(IL-6)、白介素-8(IL-8)、TNF-α及白介素-10(IL-10)水平。所得数据用SAS6.14统计软件对数据进行相关分析。结果转流后各组血浆中IL-6、IL-8及TNF-α水平均明显高于基础值(P<0.05),其中人工肺组在不同时点明显高于自体肺组(P<0.05);CPB开始后血浆中IL-10水平明显升高(P<0.05),人工肺组在不同时点低于自体肺组(P<0.05)。结论心脏手术CPB诱导了SIR及抗炎反应,自体CPB降低了血浆中促炎性细胞因子的水平,促使抗炎性细胞因子IL-10的生成,抑制炎症反应。

Objective To study the effect of CPB on SIR. Methods Twelve adult mongrels were randomly divided into two groups,6 for own-lung group, in which the dog＇s own lung was used as oxygenator;6 for artifical - lung group in which the artificial lung （bubble oxygenator） was used as oxygenator. The technique of myocardium protection and cardiac arrest were same in both groups. CPB was controlled running for 1 hour in both groups. The blood samples were collected in both groups at the time points of preoperation, 30rain of aortic on-clamping, 5, 60min,1,2,4h of post aotic off-clamping. Plasma concentration of IL-6, IL-8,TNF-α, IL-10 was detected with ELISA. Results After the running of CPB, plasma levels of IL-6, IL-8,TNF-α were significantly increased at different time points in the artifical-lung group compared with those in the own-lung groups （ P 〈 0.05 ）. However, they were significantly higher than that before CPB in both groups. The anti-inflammatory IL-10 concentration was also increased significantly,but there was a lower IL-10 level in artifical-lung group than that in the own-lung group（ P 〈 0.05 ）. Conclusion CPB induces and conducts systemic inflammatory response and compensatory antiinflammatory response during heart operation, autogenous oxygenator CPB could inhibit inflammatory response and develop antiinflammatory response.