米力农对心脏瓣膜手术患者围手术期血浆C-反应蛋白及细胞因子水平影响

Effects of milrinone on serum level of CRP and cytokines during and after cardiopulmonary bypass in patients underwent replacement of cardiac valve surgery

目的 比较米力农对心肺转流下行心脏瓣膜置换术患者围手术期血浆C 反应蛋白 (CRP)及细胞因子TNF α、IL 8、IL 10水平的影响。方法 随机、双盲将择期心瓣膜置换术手术患者 16例分为两组 ,一组为米力农组 (M组 ) ,另一组为控制组 (C组 ) ;每组 8例。M组在主动脉阻断钳开放后立即静脉输入米力农负荷量 0 0 5 0mg·kg-1,10min内输完 ;继之以静脉输注维持量米力农 2× 10 -4mg·kg-1·min-1;C组以同样方法注入安慰剂。分别于全麻诱导前 (基础 ,T1)、主动脉开放后 (T2 )、心肺转流停机后 (T3 )、术毕(T4)、术后 2 4h(T5)、术后 4 8h(T6)抽取患者中心静脉血 ,采用放射免疫法定量测定TNF α、IL 8、IL 10的血浆水平 ;采用放射免疫分析法定量测定CRP血浆水平。结果 M组和C组TNF α在T1、T2 、T3 、T4、T5、T6血浆浓度相比较差异无显著性 (P >0 0 5 ) ,但M组T2 较T1减低 (P <0 0 5 )。CRP在T5、T6时 ,M组高于C组 (P <0 0 5 )。IL 8血浆浓度在T4时 ,M组值高于C组 ,差异具有显著性 (P <0 0 5 ) ;IL 10血浆浓度在T5、T6位点上 ,M组值高于C组 ,差异具有显著性 (P <0 0 5 )。CRP在M组和C组中术后 2 4h和术后 4 8h均较T1有显著升高 (P <0 0 5 ) ;IL 8在M组和C组中T2 、T3 、T4、T5、T6时均增高 (P <0 0 5 )?

AIM To compare the effects of milrinone on serum level of CRP, TNF α, IL 8, and IL 10 during and after cardiopulmonary bypass (CPB) in patients underwent replacement of cardiac valve surgery. METHODS Prospective, randomized, double blind study. Sixteen patients scheduled for replacement of cardiac valve surgery divided into 2 groups: (1) milrinone group(M), (2)controlled group(C). Patients received a loading dose of 50 microg·kg -1 of milrinone followed by an intravenous infusion of 0 2 microg·kg -1 ·min -1 or placebo immediately after aortic declamping. Blood samples for cytokines and CRP measurements were collected into EDTA Vacutainers from central vein at the following time: just prior to induction of anesthesia (baseline, T 1), 5 min after aortic cross clamp release (T 2), 5 min after weaning from CPB (end CPB, T 3), on completion of surgery (T 4), 24 hours (T 5) and 48 hours(T 6) after the operation. Concentrations of TNF α, IL 8, IL 10, and CRP on blood serum were measured by radio immunoassay (RIA). RESULTS There were no significant differences in the changes of TNF α( P >0 05) in the group C as compared with the group M and with it's own baseline in group C. But TNF α increased significantly at T 3 compared with T 1 in group M. Compared with baseline a significant increase of CRP in the group M and C at T 5 and T 6 each was emerged and the value in group M at the same time points was much more higher than the one in M ( P <0 05). On the contrary, there was no significant increase in IL 8 in the group M compared with group C at T 1～T 6 except at T 4, at which the value of M group was higher than the one in group C and there was a significant increase in both groups compared with baseline at T 1～T 6 ( P <0 05). IL 10 level was seen increased more in the group M than group C at T 5 and T 6 and compared with the baseline the results in group was higher at T 4～T 6 and the results in group C was higher at T 5 and T 6 ( P <0 05). CONCLUSION Milrinone inhibited systemic inflammation induced by CPB and the operation of replacement of cardiac valve surgery in adults.