肝素涂层膜肺对心肺转流时血液IL-6、IL-8水平和肺功能的影响

The effect of heparin - coated membrane oxygenator on the IL - 6, IL - 8 and lung function following cardiopulmonary bypass

目的 观察使用肝素涂层的膜肺对心肺转流时血液中炎性细胞因子IL-6、IL-8水平和肺功能的影响.方法 29例择期双瓣膜置换术患者,随机分为肝素涂层膜肺组（H组,n=15）和普通膜肺组（C组,n=14）.术中持续监测ECG、HR、SpO2、MAP、CVP、心排血量（CO）;术前、体外循环（CPB）前、主动脉开放前及开放0.5、1、2、6 h时点测定IL-6、IL-8水平;术前、CPB前及主动脉开放1.5、2、6 h时点测定血气,计算肺泡-动脉氧分压差（PA-aDO2）和氧合指数（PaO2/FiO2）,同期监测气道压并计算肺的顺应性.结果 2组患者在主动脉开放前、开放0.5、1、2、6 h各时点IL-6、IL-8水平均较术前显著升高（P＜0.01）;开放前、开放0.5、1 h时点H组IL-6、IL-8较C组明显降低（P＜0.05）,CPB前及开放2、6 h时点H组IL-6、IL-8较C组轻度降低（P＞0.05）.2组开放后各时点较CPB前气道阻力轻度升高,但2组间差异无显著性.2组患者主动脉开放1.5、2、6 h与术前相比PA-aDO2显著增加、PaO2/FiO2显著降低（P＜0.01）,但H组和C组间各时点差异无统计学意义（P＞0.05）.结论 单纯肝素涂层膜肺可在一定程度上降低炎性细胞因子水平,但对肺功能无明显保护作用.

Objective To study the effect of heparin - coated membrane oxygenator on the inflammatory mediators IL - 6, IL - 8 and lung function following cardiopulmonary bypass. Methods Twenty - nine adult patients were random- ly assigned into two groups undergoing elective dual valves replacement（ aortic valve and mitral valve） with either a hepa- rin - coated membrane oxygenator （ group H, n = 15 ） or an uncoated membrane oxygenator（ group C, n = 14）. Monitoring techniques （ electrocardiogram, radial artery pressure, central venous pressure, pulmonary arterial pressure, cardiac output, airway pressure） were used in all patients. Artery blood samples were obtained at the following seven points in both groups： before the operation （after the induction of anesthesia） , before the initiation of CPB, before aortic declamping, after aortic declamping （0.5 h, 1 h, 2 h, 6 h） to measure the levels of IL - 6, IL - 8 and blood gas analysis ; Airway pressure were recorded at the following five points in both groups： before the operation（ after the induction of anesthesia） , before the initiation of CPB, after aortic declamping （ 1.5 h, 2 h, 6 h） ; Alveolar - arterial oxygen difference （ PA-a DO2 ） , oxygenation index （ PaO2/FiO2 ） and the pulmonary compliance were calculated. Result The levels of IL - 6, IL - 8 before aortic declamping, 0.5 h, I h, 2 h, 6 h after aortic deelamping were significantly higher than the levels after induction of anesthesia in two groups （ P 〈 0.01 ）. The levels of IL - 6, IL - 8 in C group were significantly higher than that of H group at the following points ： before aortic deelamping, 0.5 h, 1 h after aortic declamping （ P 〈 0.05 ） ; There was no significant deviation before the operation, before the initiation of CPB, 2 h and 6 h after aortic declamping between C group and H group. In two groups A - aDO2 increased significantly and PaO2/FiO2 decreased significantly at 1.5 h, 2 h, 6 h after aortic declamping compared with baseline （ P 〈 0.01 ）. There was no significant difference between the C group and H group in A - aDO2 and PaO2/FiO2. The pulmonary compliance decreased and airway pressure increased in H group and C group at 1.5 h, 2 h, 6 b after aortic declamping, but no significant differences compared with baseline.Conclusion Heparincoated membrane oxygenator can significantly reduce the systemic inflammatory reaction caused by CPB. But the protection of heparin - coated membrane oxygenator on pulmonary function is limited.