去白细胞血预充对体外循环肺的保护作用

Lung Protective Effection of Leukocyte-depleted Priming Fluidon Cardiopulmonary Bypass

目的:体外循环前去除预充血液中的白细胞,探讨其对体外循环肺保护作用。方法:50例≤10岁的室间隔缺损患儿随机分成实验组和对照组,实验组用去白细胞血预充,对照组用库存全血预充。测定围术期血浆中性粒细胞弹性蛋白酶(NE)、肿瘤坏死因子-α(TNF-α)、IL-6、白介素-8含量;氧合指数(OI)、肺泡-动脉血氧分压差(P(A-a)O2)和呼吸指数(RI)及术后呼吸机通气时间。结果:实验组术后机械通气时间,体外循环后血浆中NE、TNF-α、IL-6和IL-8浓度,肺泡动脉血氧分压差和RI低于对照组(P<0.05,P<0.01),OI在体外循环后高于对照组(P<0.05)。结论:去白细胞血预充能减少中性粒细胞蛋白酶、TNF-α、IL-6和IL-8的含量,改善术后肺换气功能,缩短术后的机械通气时间,具有良好的肺保护作用。

Objective：To evaluate the lung protective effect of patients by the removal of allogeneic leukocytes in priming fluid on cardiopulmonary bypass（CPB）.Methods：Total 50 patients under 10 year-old with ventricular septal defect（VSD） repair undergoing CPB were randomly divided into experimental group and control group.The experimental group used leukocyte-removed priming fluid,and the control group used packed whole blood priming solution.The plasma levels of neutrophil elastase（NE）,tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,interleukin-8（IL-8）,oxygen index（OI）,alveolar-arterial oxygen difference（P（A-a） O2）,respiratory index（RI） of perioperation and mechanical ventilation supporting time postoperation were measured.Results：Post-operative mechanical ventilation supporting time,the level of NE,TNF-α,IL-6,IL-8,P（A-a） O2,RI were lower in experimental group than those in control group（P 0.05,P 0.01） ;and OI was higher in experimental group（P 0.05）.Conclusions：Using leukocyte-removed priming fluid could reduce the releasel of NE,TNF-α,IL-6 and IL-8,improve pulmonary oxygenation function,and is helpful for post-opertive lung protection in Patients.