不同滤出量平衡超滤对体外循环手术中炎性介质水平的影响

Effect of different balanced ultra-filtration volumes on inflammatory mediators during cardiopulmonary bypass

目的探讨不同流量平衡超滤对体外循环(CPB)中炎性介质水平变化的影响。方法将80例先天性心脏病手术患儿随机分成对照组(C组),小滤出量平衡超滤组[L组,超滤量30mL/(kg.h)],中等滤出量平衡超滤组[M组,超滤量60mL/(kg.h)],大滤出量平衡超滤组[H组,超滤量90mL/(kg.h)],各组均于体外循环停机后给予改良超滤。记录临床指标,并分别于CPB开始、结束和术后2h、12h采集动脉血标本,检测肿瘤坏死因子(TNF-a)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)指标。结果 C组各类炎症介质的浓度随转流时间的延长不断上升,各平衡超滤组中炎症介质的浓度在体外转流期间呈上升趋势,但上升幅度较小,CPB结束后各炎症介质的浓度显著低于C组(P<0.05)。各超滤组间比较,M组和H组炎性介质浓度显著低于L组(P<0.05),H组炎性介质浓度与M组相比,差异无统计学意义(P>0.05)。结论超滤液量60mL/(kg.h)是较合理的平衡超滤策略。

Objective To explore the effect of different balanced ultrafiltration （BUF） volumes on inflammatory media- tors in cardiopulmonary bypass（CBP）. Methods 80 children with congenital heart disease were randomly divided into 4 groups ： the control group （group C ）, the low ultra- filtrate volume （UFV） group E group L, UFV = 30 mL/（ kg · h） ], the moderate UFV group Egroup M, UFV =60 mL/（kg · h） ], and the high UFV group [group H, UFV =90 mL/（kg · h） ]. All of the groups were given modified ultra-filtration after termination of CPB. Serum TNF-ct, IL-6 and IL-8 were measured at the beginning and termination of CPB, and 2 and 12 hours postoperatively. Results During CPB, concen- trations of TNF-ot, IL-6 and IL-8 showed increasing trends in all groups, while the trends were less significant in UFV groups than in group C. After termination of CPB, concentrations of TNF-oL, IL-6 and IL-8 were significantly lower in UFV groups than in group C. Compared among UFV groups, concentrations of TNF-ct, IL-6 and IL-8 in group L were higher than those in groups M and H （ P 〈 0.05 ）, while they had no statistically significant difference between groups M and H. Conclusion UFV =60 mL/（kg ~ h） is more reasonable for BUF strategy.