体外循环停机后机血的不同处理对术后炎性反应的影响

Influence of different treatment to the residual blood after cardiopulmonary bypass on the inflammation after operation

目的 :研究体外循环停机后管道内机血的不同处理方式对术后炎性反应的影响。方法 :2 0 0 1年 7月 2 3日～ 11月 2 2日在我院行择期体外循环下冠脉搭桥手术的 2 4例患者随机分为试验组 (血液回收组 )和对照组 (机血直接回输组 )。试验组将停机后管道内机血用自体 2 0 0 0型血液回收机洗涤浓缩处理后回输 ,对照组直接回输。所有患者均在麻醉后、停机后 1、6、2 4、48h测定sC5b 9、IL - 6、TNFα水平。分别测定回收机处理前后sC5b 9、IL 6、TNFα水平。所有数据均以当时测得Hct校正。结果 :机血经回收机处理后sC5b 9、IL - 6、TNFα水平显著降低。试验组中sC5b 9在停机 6、2 4、48h均显著低于对照组。IL - 6停机 48h在试验组显著低于对照组。TNFα水平以及变化率在术后两组间差异无显著性。试验组在停机 48h中性粒细胞计数显著低于对照组。结论 :停机后机血经回收机处理后可以去除机血中绝大部分炎性介质 ,经处理后回输可以降低术后部分炎性介质的水平 。

Objective: To explore the different treatment to the residual blood in the conduit after cardiopulmonary bypass (CPB) on the inflammation after coronary artery bypass grafting with CPB. Methods: Between July 23 rd ,2001 and November 22 nd,2001, 24 patients who continuously took selective CABG with cardiopulmonary bypass in our hospital were divided randomly into experiment group (autotransfusion group, AT group) and control group (non AT group), 12 patients in each group. In AT group, the residual blood in circulation conduit after CPB was processed with ATS, whereas the residual blood was retransfused directly to patients in nonAT group. The blood samples were drew in all patients at (1)right after anesthesia, (2)1 h after CPB, (3)6 h after CPB, (4)24 h after CPB and (5)48 h after CPB to determinate the levels of sC 5b-9, IL-6 and TNFα , and we also drew blood samples before and after the process of residual blood in AT group to determinate the levels of Hb, Hct, sC 5b-9, IL-6 and TNFα. All data were adjusted by Hct. Results: All patients survived. There was no difference in the levels of Hb, Hct, ALB between two groups 24 hours after operation. After ATS process, the levels of sC 5b-9, IL-6 and TNFα in residual blood were significantly decreased. The levels of sC 5b-9 were significantly lower 6 h after CPB, 24 h after CPB and 48 h after CPB in AT group than in nonAT group. There were no differences in the levels of TNFα between two groups all the time, but the alternate ratio of IL-6 at 48 h after CPB was markedly lower in AT group. Neutrophil count was significantly lower 48 h after CPB in AT group than in nonAT group. Conclusion: The process of ATS can remove a majority of cytokines and activated components of complement system in residual blood in conduit after CPB. There is no obvious hypoproteinemia after transfusion of the processed residual blood. Transfusion of the processed residual blood can partly reduce the levels of inflammation medium and relieve the inflammation after cardiopulmonary bypass.