体外循环搏动灌注额外附加能量对血管内皮功能影响的研究

Effect of surplus hemodynamic energy of pulsatile flow on vascular endothelial function during cardiopulmonary bypass

目的分析心脏手术体外循环中搏动和平流灌注模式下,血流携带能量的大小及对血管内皮细胞功能的影响。方法选取2017年1月至2017年7月本院因单纯心脏二尖瓣病变拟行心脏瓣膜替换或成形手术患者40例,随机分为搏动灌注(PP)和平流灌注(NP)两组,通过能量等效压(EEP)和附加血流动力学能量(SHE)计算搏动和平流两种灌注模式在主动脉阻断后即刻、10 min、20 min、30 min和开放前各时间点血流能量的大小,并检测麻醉诱导后(T1)、主动脉阻断后30 min(T2)、停机后30 min(T3)和术后6 h(T4)内皮素-1(ET-1)、一氧化氮(NO)、白细胞介素(IL)-6、IL-10和肿瘤坏死因子(TNF)的变化,研究搏动灌注能量传递效率对血管内皮功能和全身炎症反应的影响。结果主动脉阻断后,PP组各时段EEP和SHE明显高于NP组;ET-1在T2和T3时点PP明显高于NP组;IL-10在T2、T3和T4时点PP组明显低于NP组;组内比较,各细胞因子与基础值(T1)相比均有显著差异;术中尿量PP组明显多于NP组[(672.71±310.55)ml vs(397.79±171.74)ml];两组肌酐、尿素氮无显著差异。结论与平流模式体外循环相比较,体外循环中采用有效搏动灌注赋予血流更多能量,这些能量作用于血管内皮细胞可能影响内皮因子和炎性因子的分泌。

Objective To analyze the effect of changes in the magnitude of blood flow energy during pulsatile and non-pulsatile perfusions on vascular endothelial function. Methods From January 2017 to July 2017,40 cases of patients with mitral valve disease scheduled for mitral valve replacement or repair were randomly divided into two groups： pulsatile perfusion（ PP） and non-pulsatile perfusion（ NP）. After aortic occlusion,the magnitude of blood flow energy was calculated using energy equivalent pressure（ EEP）and surplus hemodynamic energy（ SHE） at time points of 0,10,20,30 minutes after aortic occlusion and before recirculation. The changes in the levels of endothelin-1（ ET-1）,nitric oxide（ NO）,interleukin（ IL）-6（ IL-6）,IL-10 and tumor necrotic factor（ TNF） were investigated at time points of anesthetic induction（ T1）,30 minutes after aortic occlusion（ T2）,30 minutes after CPB（ T3） and 6 hours after operation（ T4） to investigate the effect of changes in pulsatile flow energy on endothelial function and inflammatory reaction. Results The EEP and SHE of PP group were significantly higher than NP group at different time points after aortic occlusion. In PP group,ET-1 measured at T2 and T3 were significantly higher than NP group; IL-10 measured at T2,T3 and T4 were significantly lower than NP group; the intragroup comparison revealed the levels of cytokines were significantly different when compared to the baseline values at T1; the intraoperative urine volume of PP group was significantly higher than NP（ 672.71±310.55 ml vs 397.79±171.74 ml）; there was no significant difference in serum creatinine and urea nitrogen between the two groups. Conclusion Pulsatile perfusion provides more blood flow energy during cardiopulmonary bypass and the energy influences the secretion of inflammatory factors from endothelial cells.