动脉路去白细胞滤器在体外循环中的临床应用  

The Clinical Utilization and Evaluation of the Arterial Line Leukocyte-Depleted Filter in Cardiopulmonary Bypass

作　　者：倪虹[1] 龚庆成[1] 李砚平[1] 

机构地区：[1]北京安贞医院体外循环科,北京100029

出　　处：《中国体外循环杂志》2004年第2期68-71,74,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的　观察常规瓣膜手术患者体外循环 (CPB)中应用动脉路去白细胞滤器的临床使用效果及对炎症介质的影响。方法　 30例风心病患者随机分为试验组和对照组 ,各 15例 ,试验组使用动脉路去白细胞滤器LG6 ,对照组使用常规的国产动脉过滤器。测定血细胞计数及分类、血浆丙二醛 (MDA)、髓过氧化物酶 (MPO)、白介素 - 1β(IL - 1β)和白介素 - 8(IL - 8) ,动脉血气分析。观察两组术前、注射鱼精蛋白后和术后 4h的氧合指数及气道压力。用Swan -ganz导管监测肺血管压力及阻力。结果　白细胞计数 :实验组 -右房 (8.4 7± 2 .0 1)× 10 9/L、左房(7.96± 2 .2 7)× 10 9/L(P >0 .0 5 ) ,对照组右房 (10 .6 9± 2 .4 7)× 10 9/L、左房 (9.6 7± 1.98)× 10 9/L(P <.0 0 1)。血小板和红细胞压积两组无差异。术后肺氧合指数 (PaO2 /FiO2 × 10 0 )两组间无统计学差异。术后其它肺参数如肺血管阻力 (PVR)、平均肺动脉压 (MPAP)、肺毛细血管楔压 (PCWP)和气道压力等两组间无统计学差异。血浆MDA ,MPO ,IL - 1β和IL - 8两组间无统计学差异。结论　CPB中应用动脉路去白细胞滤器可暂时减少循环血液中的白细胞和中性粒细胞数量 ,减少再灌注过程中白细胞的肺内滞留 ,对术后肺功能没有明显的保护作用。OBJECTIVE The aim of the present study is to evaluate the effects of the arterial line leukocyte-depleted filter and standard arterial line filter on biochemical and clinical outcome in patients undergoing valve replacement or repair operations using CPB.METHODS Thirty patients undergoing valve replacement or repair operations were randomly allocated to a leukocyte-depleted filter group (LF:15 patients) or a control group (CO:15 patients).In group LF, we used a leukocyte-depleted arterial line filter. In group CO,we used a standard filter . We analyzed blood count,and differential count the concentrations of malondialdehyde,myeloperoxidase,interleukin-1β and interleukin-8 and arterial blood gases. We observed pulmonary oxygenation index (PaO 2/FiO 2×100),and airway pressure at 3 points: before CPB,after protamine administration and 4 hours after CPB.Pulmonary artery pressure and resistance were monitored by Swan-ganz.RESULTS Group LF:WBC in right atrium (8.47±2.01)×10 9/L vs left atrium (7.96±2.27)×10 9/L( P >0.05),group CO: WBC in right atrium (10.69±2.47)×109/L vs left atrium (9.67±1.98)×10 9/L( P <0.001)。Perioperatively circulating platelets and HCT did not show any significant difference between the two groups. Pulmonary function tested by pulmonary oxygenation index did not show significant difference between the two groups.Other pulmonary data such as PVR,MPAP,PCWP,and airway pressure were similar in both groups. There were no significant differences between the groups with regard to plasma MDA,MPO,IL-1β,and IL-8 concentrations.CONCLUSION An arterial line leukocyte-depleted filter (LG-6) transiently reduced the white blood cells count and nentrophilic lenkocytes,it also reduced the WBC sequestration in lung during reperfusion,but in this study,leukocyte depletion did not show any additional effects on pulmonary protection .

关 键 词：动脉 去白细胞滤器 临床应用 术后 对照组 体外循环 氧合指数 IL—8 MPO CPB 

分 类 号：R654.1[医药卫生—外科学]