高渗盐水对体外循环病人血流动力学指标和促炎性细胞因子的影响

Effect of Hypertonic Saline on Hemodynamics and Proinflammatory Cytok ine Following Cardiopulmonary Bypass

目的 :探讨 7.5%的高渗盐水 (HS)对体外循环 (CPB)诱发的促炎性细胞因子的影响。方法 :2 0例因瓣膜病拟在CPB下行瓣膜替换术的病人 ,随机分为HS组和对照组 (n均 =10 )。HS组于体外转流开始时按 4ml/kg体重静脉输注HS ,对照组则采用等量生理盐水(NS)输注 ,均在 5min内输完。分别于术前 (T1 )、CPB开始后 50min(T2 )、CPB停止后 2h(T3 )、4h(T4)及 2 4h(T5)各时点测定动脉血清中的肿瘤坏死因子 a(TNF a)、白细胞介素 6 (IL 6 )和白细胞介素 8(IL 8)的浓度。并观察病人的血流动力学变化。结果 :与术前的基础值比较 ,二组各时点的TNF a、IL 6和IL 8的浓度均明显升高 (P<0 .0 5～ 0 .0 1) ;而HS组TNF a、IL 6和IL 8浓度在T2 ～T5各时点显著低于对照组 (P <0 .0 5)。且与NS比较HS有显著的循环稳定作用。结论 :HS能有效改善血流动力学 ;

To investigate the effects of hypertonic saline (HS) on cardiopulmonary bypass induced proinflammatory cytokine response. Method: Twenty adult patients undergoing cardiac valve replaceme nt were randomly divided into group NS and group HS( n =10 in each group).In t he group HS,HS 4 ml/kg was intravenously given when the initiation of hypothermi c CPB.The patients in group NS were given equal normal sodium.Blood samples were taken from radical artery before operation (T 1)?50 min after CPB(T 2) and 2 h(T 3)?4 h(T 4) and 24 h(T 5) after weaning from CPB for determination of p lasma levels of tumor necrosis factor a (TNF a),interleukin 6 (IL 6),and int erleukin 8(IL 8).Results: The age?body weight?aortic cross clamp time?CPB tim e and duration of operation were comparable between the two groups.In both group s TNF a?IL 6 and IL 8,increased significantly from T 2～T 5,were significa ntly lower in group HS than those in group NS( P <0.05).And changes in hemody namics was significantly different in both groups.Conclusion: HS is effective in reducing CPB induced proinflamma tory cytokine response.