体外循环生理性搏动灌注与内脏白细胞隔离及TNF-α形成影响的探讨

The effect of pulsatile perfusion on viscera leukocyte sequestration and cytokine formation

目的 :本研究旨在通过体外循体 ( CPB)生理性搏动灌注 ( PF)的实现 ,及其对内脏 (肝、胃肠 )白细胞隔离效应及肿瘤坏死因子 ( TNF-α)含量的影响 ,探讨 CPB致全身性炎症反应的机理及探寻减轻或消除此种反应的措施。方法 :10例风心瓣膜病人于 CPB期间不同时点于上、下腔静脉采血 ,由 H10型全血细胞分析仪自动计数白细胞 ,并应用一步夹心酶联免疫法定量测定 CPB期间不同时点的 TNF- α含量。结果 :生理性搏动灌注实现前 ,下腔静脉血内白细胞计数低于上腔静脉 ( P<0 .0 5) ,实现后两者无差异 ( P>0 .0 5)。于 CPB期间 TNF-α含量增高。结论 :生理性搏动灌注实现后几天内脏白细胞隔离作用 ,仍引起 TNF- α增加 。

Objective:To determine whether viscera (liver,intestine ) leukocyte sequestration and tumor necrosis factor-α exist during physiologic pulsatile perfusion. Method:Ten patients who underwent heart valve replacements were chosen at this study.The blood was serially sampled from inferior and superior vena cava for leukocyte count,and the blood from oxygenator for tumor necrosis factor- α detection.Result:The leukocytes were significantlower in blood from inferior vena cava than superior before physiologic pulastile perfusion.There was no difference of leukocytes be- tween inferior and superior vena cava after physiologic pulsatile perfusion achievement(P>0 .0 5 ) . Tumor necrosis fac- tor-α was detected,but There was no difference between differenttime points. Conclusion:These results suggested that pulsatile perfusion dosn't induce viscera leukocyte sequestration and littlely increase cytokine formation,which m ay de- crease systemic inflammatory response to cardiopulmonary bypass.