体外循环前后血中可溶性细胞间粘附分子-1、肿瘤坏死因子-α及尿微量白蛋白变化的观察

Changes of plasma soluble intercellular adhesion molecules 1, tumor necrosis factor α and urinary microalbumin during cardiopulmonary bypass

目的 观察先天性心脏病患者体外循环下心脏直视手术前后血中可溶性细胞间粘附分子 1(sICAM 1)、肿瘤坏死因子 α(TNF α)及尿微量白蛋白 (U Mal)的变化 ,探讨体外循环对血管内皮细胞损伤或激活及血管通透性的影响。方法 于诱导麻醉期间、体外循环结束、停机 2、4h、术后第 1天清晨取血及尿标本 ,分别用酶联免疫吸附法测定sICAM 1和放射免疫法测定TNF α及U Mal的浓度。结果 体外循环结束后2、4h及术后第 1天清晨sICAM 1和U Mal浓度较体外循环前显著升高 (P <0 .0 5 ) ;而TNF α浓度只在体外循环结束及停机后 2h显著高于体外循环前 (P <0 .0 5 )。结论 体外循环可诱导炎症反应致内皮细胞损伤或激活 。

Objective To observe the changes of soluble intercellular adhesion molecules 1 (sICAM 1), tumor necrosis factor α(TNF α)and urinary microalbumin (U Mal) in children during cardiac operations for studying the effect of cardiopulmonary bypass (CPB) on the injury or activation of endothelial cell and vascular permeability. Methods Twenty children undergone cardiac operation with CPB were selected in the study. Plasma concentrations of sICAM 1, TNF α and U Mal were measured with enzyme linked immunosorbent assays and radioimmunity method at the following time points: during anesthetic induction period (baseline), at the end of CPB, 2, 4 hours after the termination of CPB and on the morning of first day postoperation. Results The concentrations of sICAM 1 and U Mal was increased since 2 h after the termination of CPB and remained higher than those of the baseline, while the concentration of TNT α was only increased at the end of CPB and 2h after the termination of CPB. Conclusion CPB can induce inflammatory reaction and cause vascular endothelial cell activation or damage and increase vascular permeability.