体外循环时间及主动脉阻断时间不同时再灌注后细胞因子的变化及其与心功能的关系

Change of Cytokin and Its Correlation to Cardiac Function after Reperfusion from Different Duration of Prolonged Cardiopulmonary Bypsaa (CPB)and Aortic Cross-Clamp

目的 :探讨在体外循环时间和主动脉阻断时间不同时再灌注后细胞因子的变化及其与心功能的关系。方法 :12条雄性杂种狼犬 ,按体外循环升主动脉阻断时间不同分为两组 ,组Ⅰ (n =6 ) :主动脉阻断 2 5min ,组Ⅱ(n =6 ) :主动脉阻断 15 0min。分别于转流前和再灌注后 180min抽取动脉血检测肿瘤坏死因子α (TNF -α)和白细胞介素 6 (IL - 6 )的水平 ,监测血流动力学。结果 :再灌注后血浆TNF -α和IL - 6与转流前比较组Ⅰ无明显升高 (P >0 0 5 ) ;组Ⅱ与转流前比较显著升高 ,转流后两组之间比较组Ⅱ明显高于组Ⅰ (P均 <0 0 5 )。终止体外循环后组Ⅰ心功能无明显变化 (P >0 0 5 ) ,组Ⅱ平均动脉压、心脏指数、每搏指数、左心室每搏作功指数均显著降低并低于组Ⅰ (P <0 0 5 ) ,TNF -α和LI- 6与上述心功能指标呈明显的负相关。结论 :长时间体外循环和主动脉阻断是造成再灌注后细胞因子升高的主要原因 ;

Objective:To explore the change of cytokin and its correlation to cardiac function after reperfusion from different duratices of prolonged CPB and aortic cross-clamp.Methods:Twelve male mongrel wolf dogs under CPB were randomly divided into two groups,groupⅠ(n=6),aortic cross-clamp for 25 min and group Ⅱ(n=6),aortic cross-clamp for 150 min.Tumor necrosis factor-alpha(TNF-α)and interleukin 6(IL-6)in the arterial blood were detected at pre-bypass and 180min after reperfusion,respectively.Hemodynamics were detected at pre-bypass,180min after reperfusion,respectively.Results:At 180min after reperfusion,the levels of TNF-α and IL-6 were increased significantly as compared with those of the pre-bypass in groupⅠ(P>0.05),but were increased markedly in groupⅡ(P<0.05),and the difference between two groups was significant(P<0.05).The MBP,CI,SVI and LVSVWI renained unchanged as compared with those of pre-bypass in groupⅠ(P>0.05),but siginficantly decreased in group Ⅱ,and there was significant difference between the two groups at 180min after reperfusion (P<0.05).The levels of TNF-α and IL-6 were negatively correlated to the MBP,CI,SVI and LVSWI.Conclusion:Prolonged CPB and aortic cross-clamp were the primary causes resulting in the increase of cytokin.The level of cytokin was negatively correlated to cardiac function after myocardial ischemia reperfusion during CPB.