PGE1联合PHC对先心病患儿CPB手术围术期炎症因子的影响

Effect of PGE1 combined with PHC on inflammatory factors during perioperative period of CPB in children with congenital heart disease

目的 观察前列地尔(PGE1)联合盐酸戊乙奎醚(PHC)对先心病患儿体外循环(CPB)手术围术期炎症因子的影响。方法 将40例先心病拟行CPB修补术患儿均分为对照组(预冲液中加入生理盐水)、PGE1组(预冲液中加入PGE1)、PHC组(预冲液中加入PHC)、联合组(预冲液中加入PGE1和PHC)。比较各组患儿体外循环开始时(T0)、心脏复跳后20 min(T1)、体外循环停止后1 h(T2)、2 h(T3)、24 h(T4)血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)水平及全身炎症反应综合征(SIRS)评分。结果 各组在T1~T4时血清IL-6、IL-8、TNF-α水平均高于T0时,且T2时血清IL-6、IL-8、TNF-α水平最高(P<0.05)。PGE1组、PHC组及联合组在T3时血清IL-6水平均低于对照组(P<0.05),且联合组在T2时血清IL-6水平低于对照组(P<0.05)。联合组在T3时血清IL-8水平低于对照组(P<0.05)。联合组在T2、T3时血清TNF-α水平、SIRS评分均低于对照组(P<0.05)。PGE1组、PHC组、联合组术后并发症发生率均低于对照组(P<0.05),但3组间差异无显著性(P>0.05)。结论 PGE1联合PHC可降低CPB停止后1 h、2 h内血液IL-6、IL-8、TNF-α炎症细胞因子水平,降低术后并发症的发生率。

Aim To observe the effect of prostandin E1(PGE1)combined with penehyclidine hydrochloride(PHC)on inflammatory factors during perioperative period of cardiopulmonary bypass(CPB)in children with congenital heart disease.Methods 40 children with congenital heart disease who were going to undergo CPB repair were divided into control group(saline into the preflushing fluid),PGE1 group(PGE1 into the preflushing fluid),PHC group(PHC into the preflushing fluid),combined group(PGE1 and PHC into the preflushing fluid).The levels of serum interleukin-6(IL-6),IL-8 and tumor necrosis factor-α(TNF-α)and systemic inflammatory response syndrome(SIRS)in each group were compared before cardiopulmonary bypass(T0),20 minutes after cardiac resuscitation(T1),1 hour after cardiopulmonary bypass(T2),2 hours(T3),24 hours(T4)after cardiopulmonary bypass.Results Serum levels of IL-6,IL-8 and TNF-αin all groups were higher at T1-T4 than at T0,and the serum levels of IL-6,IL-8 and TNF-αwere the highest at T2 time point(P<0.05).The serum IL-6 level in PGE1 group,PHC group and combination group was lower than that in control group at T3 time point(P<0.05),and the serum IL-6 level in combination group was also lower than that in control group at T2 time point(P<0.05).The serum IL-8 level in combination group was lower than that in control group at T3 time point(P<0.05).The serum TNF-αlevel and SIRS score in combination group were lower than those in control group at T2 and T3 time points(P<0.05).The incidence of postoperative complications in PGE1 group,PHC group,and combination group was lower than that in the control group(P<0.05),but there was no significant difference among the three groups(P>0.05).Conclusion PGE1 combined with PHC can reduce blood IL-6,IL-8 and TNF within 1 h and 2 h after CPB stop-αThe level of inflammatory cytokines can reduce the incidence of adverse complications after operation.