氟比洛芬对心肺转流室间隔缺损患儿肿瘤坏死因子-α、白细胞介素-6的影响

Effect of flurbiprofen on tumor necrosis factor-α,and interleukin-6 in children undergoing cardiopulmonary bypass

目的:探讨氟比洛芬(flurbiprofen axetil,FA)对心肺转流(CPB)心内手术患儿血浆肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平的影响。方法:选择20例在CPB下行心内直视手术的室间隔缺损(ventricular septal defect,VSD)患儿,随机均分为FA组(F组)和对照组(C组)。F组在麻醉后切皮前15 min给予FA1 mg/kg,C组用等容量脂肪乳剂代替。分别于麻醉后切皮前10 min(基础值,T1)、主动脉开放10 min(T2)、CPB结束后30 min(T3)、4 h(T4)、24 h(T5)、48 h(T6)测定血浆TNF-α、IL-6水平。记录呼吸机辅助时间、围术期血管活性药物使用量等。结果:与T1相比,2组患者T3和T5时点TNF-α血浆水平均增高(P<0.05～P<0.01),F组在T3时点血浆浓度低于C组(P<0.01)。与T1比较,C组在T2～6时点IL-6水平增高(P<0.05～P<0.01),F组在T2、T3和T6时点均较C组降低(P<0.01)。患儿术后呼吸机辅助时间差异无统计学意义(P>0.05);围术期多巴胺使用量差异有统计学意义(P<0.05);术毕ICU留住时间差异无统计学意义(P>0.05)。结论:FA可抑制CPB期间促炎性细胞因子TNF-α、IL-6的生成和释放,有助于患儿围术期血流动力学稳定,促进患儿早期康复。

Objective：To investigate the influence of flurbiprofen on cytokines tumor necrosis factor-α（TNF-α）,and interleukin-6（IL-6） in children undergoing cardiopulmonary bypass（CPB）.Methods：In this pilot,prospective,and randomized double-blinded study,twenty children with cardiac function classⅠ-Ⅱ scheduled for repairing ventricular septal defect were divided into two groups：children in flurbiprofen group（F group,n=10）were received 1 mg/kg flurbiprofen 15 min before skin incision and children in control group（C group,n=10）were received 0.1 ml/kg intralipid instead of flurbiprofen.Blood samples were taken 10 min before skin incision（T1）,10 min after aorta declamped（T2）,30 min（T3）,4 h（T4）,24 h（T5）,48 h（T6）after termination of CPB for determination of plasma TNF-α and IL-6 concentration.Results：The plasma TNF-α levels was higher at T3 and T5 compared to baseline（P0.05-P0.01）,but F group was lower than in C group at T3（P0.01）.IL-6 was higher during T2-T6 in C group（P0.05-P0.01） compared to T1,but F group was lower than C group at T2,T3 and T6（P0.01）.Conclusions：Flurbiprofen is effective for reducing CPB-induced inflammatory response and it is benefitful for maintaining stability of circulation.