一次性贮血滤血器对心肺转流术后炎症反应和肝肾功能的影响

Effects of disposable blood storage filter on inflammation hepatic and renal func⁃tion after cardiopulmonary bypass

目的探究一次性使用贮血滤血器是否能减轻心肺转流(CPB)引起的炎症反应,以及对患者术后肝肾功能恢复的影响。方法本研究共纳入体外循环手术患者101例,根据随机分配原则,这些患者分别被纳入实验组(E组)和对照组(C组),实验组为使用一次性使用贮血滤血器组(n=50),对照组为不使用一次性贮血滤血器组(n=51)。于手术前(T1)、CPB开始前(T2)、CPB结束时(T3)、手术结束时(T4)、术后24 h(T5)、术后48 h(T6)六个时间点分别检测患者肿瘤坏死因子-α(TNF-α)、白介素(IL)-6、IL-10的浓度。收集两组患者T1、T4、T5、T6四个时间点的血常规、凝血常规和肝肾功能指标,使用双侧t检验进行比较。结果两组患者围术期一般情况及术前化验指标无明显差异(P>0.05)。两组患者TNF-α的浓度从T2即开始增加,T4和T5维持较高浓度,至T6浓度开始下降;IL-6的浓度从T2开始增加,至T4浓度达到高峰,随后开始下降;IL-10的浓度在T3达到高峰,随后开始下降。组间进行比较,E组在T3、T4、T5时TNF-α浓度均低于C组;在T3、T5时IL-6浓度均低于C组;在T3时IL-10浓度高于C组。两组患者在T6的丙氨酸转移酶有差异(P<0.05)。结论体外循环术中使用一次性使用贮血滤血器能减轻术后炎症反应,减轻术后肝功能损伤,对术后肾功能无影响。

Objective To explore whether disposable blood storage filter could reduce the inflammatory reaction caused by car⁃diopulmonary bypass(CPB)and its effects on the recovery of hepatic and renal function after operation.Methods A total of 101 pa⁃tients underwent surgery with CPB were enrolled and randomly divided into experimental group(group E,n=50)and control group(group C,n=51)according to whether applied disposable blood storage filter.The concentrations of TNF-α,IL-6 and IL-10 were measured at four time points:before the operation(T1),before the beginning of CPB(T2),at the end of CPB(T3),at the end of operation(T4),24 and 48 hours after the operation(T5 and T6).The data of blood routine,coagulation,hepatic and renal function at T1,T4,T5 and T6 time points were collected for statistcal analysis.Results There was no significant difference in perioperative general condition and preoperative laboratory indexes between the two groups(P>0.05).In both groups,the concentration of TNF-αincreased at T2,and remained a higher concentration at T4 and T5,but decreased from T6;the concentration of IL-6 increased from T2,reached its peak at T4,and then began to decline;the concentration of IL-10 reached its peak at T3,and then began to decline.Compared to group C,TNF-αwas significantly decreased at T3,T4 and T5,the same was with IL-6 at T3 and T5,however,IL-10 was significantly increased at T3 in group E.There was significant difference in ALT at T6 between the two groups.Conclusion The application of disposable blood storage filter during CPB could reduce postoperative inflammatory reaction and improve postoperative he⁃patic function,but has no effect on renal function.