常温与低温体外循环心脏直视手术对细胞因子及补体的影响

Effects of open heart surgery under normothermic and hypothermic cardiopulmonary bypass on cytokines and complements

目的探讨常温及低温体外循环心脏直视手术对细胞因子及补体的影响.方法选择先天性和风湿性心脏病患者40例,随机分为常温组及低温组各20例,分别于术晨、体外循环结束时及术后1、4、7、14 d抽取患者静脉血标本,测定血浆TNF、IL-2、C3、C4值.结果两组术前各项检查指标无显著差异.(1)两组术后1～4d的IL-2水平较术前显著下降,至术后7 d恢复正常.体外循环结束至术后4 d,低温组IL-2显著低于常温组.(2)体外循环结束时以及术后1、4、7 d,常温组TNF水平显著低于低温组.两组体外循环结束时及术后1、4 d均高于术前,常温组至术后7 d、低温组术后14 d恢复正常.(3)体外循环结束时及术后1、7 d,常温组C3水平高于低温组,术后4 d两组无差别;常温组及低温组于体外循环结束时、术后1、4 d均低于术前,至术后7 d常温组恢复正常,低温组至术后14d恢复至术前水平.(4)两组体外循环结束时及术后1、4 dC4水平均低于术前.体外循环结束时、术后1 d,常温组C4水平高于低温组.结论常温体外循环心脏直视手术对细胞因子及补体的影响显著轻于低温组,因而对术后机体的恢复优于低温方法.

Objective To explore the detrimental influence of normothermic and hypothermic cardiopulmonary bypass duringopen heart surgery on cytokines and complements. Method Forty patients with congenital or rheumatic heart disease wererandomized into 2 groups to receive normothermic cardiopulmonary bypass (CPB, study group, n=20) or hypothermic CPB (control group, n=20). Venous blood samples were respectively collected at scheduled time points preoperatively, at the end ofCPB, and 1,4,7,14 d postoperatively to examine the level of interleukin (IL)-2, tumor necrosis factor (TNF)-α, C3, and C4.Results IL-2 in both groups decreased significantly at the end of CPB, postoperative day 1 and 4, but recovered the normallevel at day 7 postoperatively. IL-2 in control group was significantly lower than that in the study group at each time points atthe end of CPB and day 1 and 4 postoperatively. TNF-αin two groups was both elevated at the time points cited above, and inthe study group, recovery of normal TNF-αlevel occurred at day 7 postoperatively, whereas in the control group, the recoverywas not achieved until postoperative day 14. C3 in the study group was significantly lower at the time points of the end of CPB,day 1, 7 postoperatively than that in control group, but both elevated above normal at the end of CPB, day 1, and 4 postopera-tively; in the study group, C3 became normal at day 7 postoperatively, which occurred in the control group only till day 14postoperatively. At the end of CPB and day 1 postoperatively, C4 was significantly lower in the study group than in the controlgroup, both below the level measured preoperatively at the time points of the end of CPB, day 1 and 4 postoperatively.Conclusion Open-heart surgery under normothermic CPB has less detrimental influence on cytokines and complements thanthe operation under hypothermic CPB for better recovery of the patient.