不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

The effect of different oxygenators on polymorphonuclear monary bypass

目的研究小儿体外循环（cardiopulmonary bypass，CPB）中不同氧合器对中性粒细胞（PMN）凋亡的影响，为减轻体外循环全身炎症反应提供新的思路。方法将60例室间隔缺损患儿随机分为两组（n=30）：西京-90鼓泡式氧合器组（B组）和希健-Ⅱ膜式氧合器组（M组）。分别于CPB前、CPB结束时、CPB结束后4、8、24h 5个时点采取静脉血，以全血细胞计数仪测定PMN数量，流式细胞仪测定PMN凋亡率和PMN表面黏附分子CD11b表达变化，ELISA法测定血浆弹性蛋白酶浓度。结果两组患者CPB结束后PMN凋亡率明显降低（P〈0．05），PMN数量、CD11b表达、血浆弹性蛋白酶浓度明显升高（P〈0．05），在CPB结束时及CPB结束后4、8hPMN凋亡率M组均高于B组（P〈0．05）；而PMN数量、CD11b表达、血浆弹性蛋白酶水平B组均高于M组（P〈0．05）。CPB结束后24h PMN数量B组高于M组（P〈0．05）。结论与西京-90鼓泡氧合器相比，应用希健-Ⅱ膜式氧合器可以减轻CPB对PMN凋亡的抑制，进而减轻全身炎症反应。

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil （PMN） apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome（SIRS） to cardiopulmonary bypass（ CPB ）. Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups（n = 30）： group B（bubble oxygenator）, group M（membrane oxygenator）. Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow cytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced （P〈 0.05 ） and the PMN counts, the expression of CD11b and the plasma concentration of elastase were remarkably increased after CPB（P〈0.05）, but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CD11b and the plasma concentration of elastase were higher in group B than in group M （P〈0.05）. The PMN counts were higher in group B than in group M 24 h after CPB （P〈 0.05 ）. Conclusion XiJian-11 membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.