心脏手术中小剂量抑肽酶对中性粒细胞CD_(11b)/CD_(18)表达的影响

The effect of low-dose aprotinin on the expression of neutrophil CD_(11b)/CD_(18) in open heart surgery

目的 探讨体外循环术（ＣＰＢ）中小剂量抑肽酶对全身炎性反应的抑制作用。方法２８例首次行心脏瓣膜置换术患者随机分为对照组和抑肽酶组，各１４例，于麻醉诱导前、ＣＰＢ前、ＣＰＢ结束后１ｈ及２４ｈ用免疫流式细胞仪分别测定中性粒细胞表面粘附分子ＣＤ１１ｂ和ＣＤ１８的表达。结果ＣＤ１１ｂ／ＣＤ１８的表达与ＣＰＢ时间呈正相关（相关系数γ分别为０．６４４、０．５３８，Ｐ＜０．０５），ＣＰＢ结束后１ｈ及２４ｈ对照组ＣＤ１１ｂ的表达较麻醉诱导前及同时点的抑肽酶组明显上调（Ｐ＜０．０５）；ＣＤ１８的表达仅在ＣＰＢ结束后１ｈ明显上调并高于抑肽酶组（Ｐ＜０．０５），ＣＰＢ结束后２４ｈ表达下凋有所缓解，但仍高于麻醉前基础值（Ｐ＜０．０５）。结论 ＣＰＢ所致的炎性反应可能与转机时间有关，小剂量抑肽酶对ＣＰＢ术后ＣＤ１１ｂ／ＣＤ１８表达增加具有抑制作用。

Objective To investigate the inhibition of low-dose aprotinin on systematic inflammatory response during cardiopulmonary bypass. Methods Twenty-eight ASA Ⅱ-Ⅲ patients(male 13, female 15) undergoing valve replacement were studied. The age ranged from 27 to 55 years and body weight from 37 to 70 kg. CPB time ranged from 66 to 218 mm and aortic cross clamping time from 30 to 140 min . The patients were divided into two groups: control group(n=14) and aprotinin group(n = 14) Premedication included intramuscular phenobarbital sodium 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with intravenous midazolam 0. lmg/kg, fentanyl 20-30μg/kg and vecuronium 0. 1-0. 12mg/kg, and maintained with intermittent bolus injection of fentanyl and vecuronium supplemented with isoflurane inhalation. In aprotinin group aprotinin 1×106KIU was infused after induction of anesthesia until thoracotomy, after thoracotomy aprotinin was infused at a rate of 2.5× 106 KIU/h and aprotinin 2. 5 ×106KIU was added to the prime fluid as suggested by Levy. Blood samples were obtained before anesthesia, before CPB and 1h and 24h after CPB for determination of CD11b and CD18 expression on the surface of neutrophil by immunofluoresence flow cytometry. Results The expression of CD11b or CD18 and CPB time were positively correlated(γ= 0.644, 0.538, P<0.05) . CD11b/CD18 expression was comparable before anesthesia and CPB between the two groups(P >0.05). 1 h after CPB CD11b/ CD18 expression increased significantly in the control group and was significantly higher than that in the aprotinin group, but at 24h after CPB only CD11b expression in control group was significantly higher than that in aprotinin group. In aprotinin group there was no significant difference in CD11b/CD18 expression between the four intervals.Conclusions CPB-induced systematic inflammatory response may be positively correlated with CPB time. Low dose aprotinin can inhibit the increase in CD11b/CD18 expression after CPB.