机械通气对小儿体外循环术后IL-6 IL-10及TNF-α的影响

Effects of mechanical ventilation on plasma IL-6,IL-10 and TNF-α in children after cardiopulmonary bypass

目的体外循环(CPB)术造成全身炎症因子水平升高,机械通气可能对其水平有一定影响。该文探讨不同机械通气模式对小儿CPB术后炎症因子的影响,为临床治疗提供参考。方法60例CPB术后小儿随机分为A组和B组,每组30例,A组术后接受高潮气量-低PEEP机械通气,B组接受低潮气量-高PEEP机械通气,比较两组血浆中IL-6,IL-10及TNF-α的水平在不同时间点的差异。结果两组患儿炎症因子在CPB结束时显著增高,在术后1h达到峰值。术后1h和6h,A组炎症因子水平均高于B组。结论不同的机械通气模式对CPB术后全身炎症因子水平有一定影响,低潮气量-高PEEP模式显著降低炎症因子水平。

Objective To study the effects of different models of mechanical ventilation on inflammatory cytokines, IL-6, IL-10 and TNF-α, in children after cardiopulmonary bypass （CPB）. Methods Sixty patients who underwent CPB were randomly divided into group A and group B. After CPB, group A was ventilated with high tidal volume （VT, 10-12 mL/kg） low positive end-expiratory pressure （PEEP, 3-5 cm H20） , while group B was ventilated with low VT （6-8 mL/ kg） /high PEEP （6-9 cm H2O）. Plasma levels of IL-6, IL-10 and TNF-α were measured before operation, at the end of the operation, and 1 and 6 hrs after operation. Results Serum levels of IL-6, IL-10 and TNF-α in both groups increased significantly at the end of the operation and reached a peak by 1 hr after operation. Group B showed lower serum levels of IL-6, IL-10 and TNF-α than group A 1 and 6 hrs after operation. Conclusions Mechanical ventilation with low VT/high PEEP may more effectively inhibit the release of inflammatory cytokines than that with high VT/low PEEP in children after CPB.