体外循环术中炎症介质表达与呼吸机相关性肺炎的临床研究

The clinical study of the relationship between the serum inflammatory factors expression and ventilator-associated pneumonia undergoing cardiopulmonary bypass cardiac surgery

目的:探讨体外循环(CPB)心脏手术中炎症因子表达水平对术后呼吸机相关性肺炎(VAP)发生的作用。方法:收集20例瓣膜置换患者左心房血液,其中发生呼吸机相关性肺炎患者10例(VAP组);未发生呼吸机相关性肺炎患者10例(NVAP组)。分别于体外循环开始即刻(T1),体外循环开始后20 min(T2),体外循环开始后40 min(T3),体外循环结束即刻(T4)采集患者的左心房血液,测定血浆中肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-10、IL-1β的表达水平。同时分析患者术前一般状况,术中体外循环手术情况,术后呼吸机相关性肺炎的发生发展状况。结果:两组TNF-α、IL-1β的表达水平各时间点均无显著性差异,NVAP组T3、T4时间点左心房血液中IL-10表达水平以及IL-10/TNF-α比值明显高于(VAP)组(P<0.05)。同时呼吸机相关性肺炎的发生与体外循环时间呈正相关。结论:体外循环过程中IL-10的表达升高可显著减少术后呼吸机相关性肺炎的发生。

Objective：To test whether the level of serum inflammatory factors could predict the occurrence of ventilator-associated pneumonia （VAP） undergoing cardiopulmonary bypass （CPB） cardiac surgery. Methods：Twenty valve replacement patients were categorized into two groups based on the occurence of VAP following CPB, VAP group（A） and NVAP group （B）. The blood samples of left atrium were collected in both groups at the time points of preoperation（T1 ）, 20 min after CPB（T2）,40 rain after CPB（T3 ） and end （T4） of CPB. Expression of serum IL-10,IL-1βand TNF-α were detected by ELISA. The common and CPB data of all cases in two groups were compared. Results：There was no significant difference in TNF-α and IL-1β in each time point between VAP group and NVAP group. The expression of IL-IO and IL-10/TNF-α ratio in NVAP group at the time points of T3 and T4 were significantly higher than VAP group （P 〈 0.05）. The occurance of VAP was correlated with the CPB time. Conclusion：The increase of the expression of IL-10 could significantly decrease the occurence of VAP.