CPB心脏手术对围手术期成人和小儿血浆炎性反应介质水平影响

Comparison of effects of cardiac surgery with cardiopulmonary bypass on serum level of CRP and cytokines in adults and children

目的 比较心肺转流心脏手术对成人和小儿围术期患者血浆C 反应蛋白 (CRP)及细胞因子TNF α、IL 8、IL 10水平的影响。方法 将择期心脏手术患者 16例分为两组 ,成人组 (A组 ) ,小儿组 (B组 ) ,每组 8例。分别于全麻诱导前 (基础 ,T0 )、主动脉开放后 (T1)、心肺转流停机后 (T2 )、术毕 (T3 )、术后 2 4h(T4)、术后 4 8h(T5)抽取患者中心静脉血 ,采用双抗体放免法定量测定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 组间比较A组和B组TNF α在T0 、T1、T2 、T4、T5血浆浓度相比差异无显著性 (P >0 0 5 ) ,而在T3 ,A组显著高于B组。CRP在T0 、T1、T2 、T3 、T4时 ,A组与B组比较差异没有显著性 (P >0 0 5 ) ;而在T5A组血浆浓度高于B组 ,差异具有显著性 (P <0 0 5 )。IL 8血浆浓度在T2 、T3 时 ,A组低于B组差异具有显著性 (P <0 0 5 ) ;IL 10血浆浓度A组和B组比较 ,差异无显著性 (P >0 0 5 )。组内比较A、B两组内TNF α、IL 10所测血浆浓度值和T0 相比差异无显著性 (P>0 0 5 )。CRP在A组和B组中T4和T5均较T0 升高 (P <0 0 5 ) ;IL 8在A组和B组中T1、T2 、T3 、T4、T5时均较T0 增高 (P <0 0 5 )。结论 心肺转流心脏手术所诱发的组织炎性反应小儿强于成人。

Objective To compare effects of cardiac surgery with cardiopulmonary bypass on serum level of CRP and cytokines in adults and children. Methods Prospective, randomized, double-blind study design was employed. 16 patients scheduled for cardiac surgery with CPB were divided into two groups: group A, n =8; group B, n =8. The standardized anaesthetic included fentanyl, vecuronium and midazolam. 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 0), 5 min after aortic cross-clamp release (T 1), 5 min after weaning from CPB (end-CPB, T 2), on completion of surgery (T 3), 24 hours (T 4) and 48 hours(T 5) after the operation. Concentrations of CRP, TNF-α, IL-8, and IL-10 were measured by radio immunoassay (RIA). Results No significant rise occurred in TNF-α, IL-10 in both groups except a significant reduction in T 3 in group B. Patients in group A had significant rises in T 5 CRP and significant reduction in T 3, T 4 IL-8 compared with group B ( P <0 05). Patients in group A and group B had significant rise in T 4, T 5 CRP, T 1～5 IL-8 compared with the baseline of each ( P <0 05). Conclusion Systemic inflammatory response in children undergone cardiac surgery with CPB is more severe than that in adults.