体外循环对瓣膜置换术患者肠黏膜屏障功能的影响

Effect of Cardiopulmonary Bypass on Gut Mucosal Barrier Function in Patients Undergoing Cardiac-Valve Replacement

目的:探讨围体外循环期瓣膜置换术患者肠黏膜屏障功能的变化及可能机制。方法:选择体外循环(CPB)心脏瓣膜置换术患者20例,按时点采取中心静脉血标本测定血清肠型脂肪酸结合蛋白(I-FABP)、白细胞介素(IL)-6、IL-10及D-乳酸水平,同时行静脉血气分析和血糖监测。结果:与CPB前比较,主动脉开放10min时,血清D-乳酸和I-FABP值即显著升高;术后2h血浆D-乳酸达峰值,I-FABP维持较高水平;术后6h血浆I-FABP达峰值;术后18h血清D-乳酸和I-FABP值仍高于基础值。术后6h血浆I-FABP峰值与血糖和乳酸峰值呈正相关。结论:围CPB期肠黏膜屏障功能受损。神经-内分泌-免疫系统共同参与的应激反应与肠黏膜屏障功能损伤有关。

Objective： To investigate the gut mucosal barrier function during cardiopulmonary bypass （CPB）, and the relative mechanisms thereof. Methods： Twenty patients underwent heart valve replacement with cardiopulmonary bypass were enrolled. Blood samples of the jugular vein from 20 CPB patients were drawn following 6 time points, before CPB （Tl）, 10 min after aortic crossclamp release （T2）, immediately at the end of CPB （T3）, 2 h after operation（T4）, 6 h after operation（T5） and 18 h after operation（T6）. The levels of blood intestinal fatty acid binding protein （I-FABP）, interleukin（IL）-6, IL-10 and D-lactate were detected. Blood samples were also taken for blood gas analysis and blood glucose detection. Results：Comparing with T1（before CPB）, serum concentrations of D-lactate and I-FABP elevated obviously at T2, T3, T4 and T5 （P 〈 0.05）, and reached its peak value at T5. The serum concentration of I-FABP and D-Lactate were still higher than that at T1 at T6 （P 〈 0.05）. The peak of I-FABP was correlated with peaks of serum glucose and lactate. Conclusion： The gut mucosal barrier function was damaged during CPB, which might be related to the stress response of nervous- endocrine system and immunity system.