自体肺体外循环与常规体外循环对细胞因子影响的实验对比研究

The empirical study for the effect of extracorporeal circulation with autologous lung and conventional extracorporeal circulation as oxygenator on cytokine levels

目的：探讨以自体肺取代人工肺的体外循环方法对犬体外循环相关性炎症反应的影响。方法：将12只杂种犬随机分为对照组及实验组（每组6只）。对照组在体外循环（CPB）期间使用膜式氧合器,实验组在CPB期间使用自体肺进行氧合,两组均阻断主动脉90分钟、辅助循环30分钟,于CPB前（T1）、转流后60分钟（T2）、停机后60分钟（T3）、停机后120分钟（T4）抽取动脉血,测定血浆肿瘤坏死因子α（TNFα-）、白细胞介素6（IL-6）、白细胞介素8（IL-8）和白细胞介素10（IL-10）浓度。结果：两组实验犬血浆TNFα-、IL-6、IL-8和IL-10的浓度,在T2-T4各时点与体外循环前比较均明显增加（P〈0.01）;T2-T4时点实验组血浆TNFα-、IL-6和IL-8浓度明显低于对照组（P〈0.01）,IL-10浓度明显高于对照组（P〈0.05）。结论：自体肺体外循环可抑制体外循环过程中促炎细胞因子TNFα-、IL-6和IL-8的释放,促进抗炎细胞因子IL-10的释放,从而减轻常规体外循环引起的全身炎症反应。

Objective：To determine the protective effect of cardio-pulmunary bypass（CPB） with autologons lung as oxygenator on CPB- relative inflammatory response. Methods： Twelve adult mongrel dogs were randomly divided into control group and study group. Cardiopulmonary bypass （CPB） using a membrane oxygenator （control group） or using the antologous lung （study group） for gas exchange was performed for 120 min in an alternating series of 12 mongrel dogs with the heart arrested for 90 min by crystalloid cardioplegia and 30 nfin reperfusion. The blood samples were collected at the same time point of pre-operation （T1）, 60 min of cardiopulmonary bypass （T2）, and 1 hour（ T3 ）, 2 hours （T4） after cardiopulruonary bypass. Plasma concentration of IL-6, IL-10, TNF-α were detected with ELISA. Results：The plasma levels of IL-6, IL-8, IL-10, TNF-α in each group were significantly increased at T2, T3, T4. The plasma levels of IL-6, IL-8 and TNF-α in study group were significandy lower than in the control group at T2,T3,T4.The plasma levels of IL-10 in study group were significantly higher than the levels in control group at T2, T3, T4. Conclusion： This study indicates that extracorporeal circulation with autologous lung as oxygenator could reduce the increased amplitude of plasma levels of TNF-α, IL-6 and IL-8 whereas enhance the increased amplitude of the plasma IL-10 levels that result from CPB. In other word, extracorporeal circulation with autologous lung as oxygenator possesses the effect to regulate inflammatory cytokine balance and down-regalate CPB-relative inflammatory response.