深低温低流量体外循环心脏手术对幼猪肾功能的影响

Effect of Deep Hypothermic Low-flow Cardiopulmonary Bypass Surgery on Kidney Function in Piglets

[目的]评价长时间深低温低流量体外循环(CPB)心脏手术对幼猪肾功能的影响。[方法]北京长白幼猪15例,分为实验组(n=10)和对照组(n=5)。实验组麻醉后正中开胸,常规建立体外循环,体温降至25℃后,开始低流量循环(50mL·kg-1·min-1),主动脉阻断120min后开放,停机后观察120min取肾组织;对照组麻醉后单纯开胸。对照组在麻醉诱导后即刻(T1),实验组分别在麻醉诱导后即刻(T1)、停机后5min(T2)、120min(T3)取静脉血,检测半胱氨酸蛋白酶抑制剂C(Cystatin C,CysC)、血肌酐(Serum Cratinine,SCr)、尿素氮(Blood urea nitrogen,BUN)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)。两组动物在实验结束时,测尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acetyl-β-D-glucosaminidase,NAG),取肾组织行病理检查。[结果]实验组1例死于CPB停机后心脏骤停,余9例和对照组5例完成至实验结束。对照组和实验组在T1时点各指标均无统计学差异(P>0.05);与T1的检测指标相比,实验组T2的CysC、SCr、BUN、IL-6、TNF-α分别升高33.84%(P<0.05)、22.79%(P>0.05)、30.17%(P>0.05)、55.95%(P<0.05)、44.12%(P<0.05);T3的CysC、SCr、BUN、IL-6、TNF-α分别升高77.16%、64.95%、77.37%、64.29%、35.29%(P均<0.05)。与对照组相比,实验组可见肾损伤病理学改变,尿NAG升高91.85%(P<0.05)。[结论]深低温低流量体外循环心脏手术可造成幼猪肾损伤,并证实炎症反应是肾损伤的可能机制之一。

[Objective] The purpose of this study was to evaluate the effect of prolonged deep hypothermic low-flow cardiopulmonary bypass（CPB） cardiac surgery on the renal function of piglets. [Methods] 15 Beijing Landrace piglets were divided into study group（n=10） and control group（n=5）. Routine CPB was established after median thoracotomy in study group under anesthesia. Low-flow CPB（50ml.kg-l.min-1） was started when the temperature of the animal dropped down to 25℃. The aorta was reopened after 120rain cross-clamping. Kidney tissues were harvested after 120min following CPB ceased. In control group, animals were merely received median thoracotomy under anesthesia. In control group, venous blood samples were taken immediately after anesthesia indnction（T1）, and in study group, venous blood samples were taken immediately after anesthesia indnction（T1）, 5min（T2） and 120rain（T3） after the CPB shutdown. Cystatin C（CysC）, Serum Cratinine（SCr）, blood urea nitrogen（BUN）, interleukin-6（IL-6）, and tumor necrosis factor-α（TNF-α） were tested in both groups venous blood samples. In both groups, when the experiment was terminated, urine N-acetyl-13-D-glucosaminidase（NAG） was tested, and pathological examination of kidney tissues was adopted. [Results] 1 piglet from study group was died by heart arrest after CPB, other 9 and all 5 in control group completed to the end of the experiment. Compared with control group, there was no statistics of differences of all detection index to study group in TI（P〉0.05）. In study group, compared with T1, CysC, SCr, BUN, IL-6, and TNF-α were respectively increased by 33.84%（P〈0.05）, 22.79% （P〉0.05）, 30.17%（P〉0.05）, 55.95%（P〈0.05）, 44.12%（P〈0.05） in T2, and by 77.16%, 64.95%, 77.37%, 64.29%, 35.29%（aU P〈0.05） in T3. Compared with control group, study group showed pathological changes of kidney damage, and urine NAG was increased by 91.85%（P〈0.05）. [Conclusions] Deep hypothermic low-flow CPB would result in kidney injury on piglets and its key mechanism might be inflammatory injury.