心脏瓣膜置换病人围术期炎性细胞因子变化及心肌损伤的观察  

A Clinical Observation of Peri-operative Proinflammatory Cytokines and Myocardial Injury in Patients Undergoing Cardiac Valve Replacement

作　　者：陈萍[1] 章晓华[1] 罗智超[1] 

机构地区：[1]广东省心血管病研究所心外科,广州市510100

出　　处：《岭南心血管病杂志》2004年第6期420-422,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的　观察心脏瓣膜置换病人围术期炎性细胞因子及心肌损伤指标的变化 ,探讨其临床意义。方法　以72例风湿性心脏病行瓣膜置换术的病人为研究对象 ,分别于术前、术毕、术后第 1、3、7天测量血浆白细胞介素 (IL 6、IL 8)及肿瘤坏死因子 α(TNF α) ,乳酸脱氢酶 (LDH)、磷酸肌酸激酶同工酶 (CK MB)、心肌肌钙蛋白 (cTnI)水平 ;记录呼吸机辅助时间、ICU停留时间、术后住院天数。结果　①IL 6、IL 8、TNF α在术毕、术后第 1、3天较术前显著升高。以术毕最高 ,此后逐渐下降 ,术后第 7天接近术前 ;②CK MB、LDH、cTnI在术毕、术后第 1、3天较术前显著升高。CK MB术毕最高 ,LDH、cTnI术后第 1天最高 ,此后逐渐下降 ,CK MB术后第 7天恢复至术前 ,而LDH、cTnI仍显著高于术前 ;③相关分析 ,CPB时间与术毕IL 6、IL 8及术后第 1天IL 8成显著正相关 ;术毕IL 6与LDH、cTnI ,IL 8与CK MB、LDH成显著正相关 ;术毕、术后第 1天IL 8与呼吸机辅助时间、ICU停留时间呈显著正相关 ,术毕及术后第 1天TNF α与呼吸机辅助时间、ICU停留时间呈显著正相关。结论　CPB导致全身炎性反应 ,引起炎性细胞因子的大量释放 ,在术后第 7天方恢复至术前水平 ;CPB时间与炎性细胞因子浓度、心肌损伤程度密切相关 ;Objectives To investigate the perioperative alteration of proinflammatory cytokines and myocardial injury in Patients undergoing cardiac valve replacement. Methods 72 patients with rheumatic heart disease undergoing cardiac valve replacement were included. Blood samples wrer taken before skin incision (T1), at the end of operation (T2), the first (T3), the third (T4) and the seventh (T5) postoperative day for determination of plasma IL-6, IL-8, TNF-alpha (TNF-α), CK-MB, LDH and cTnI. Results ①IL-6, IL-8, TNF-α at T2, T3, T4 were significantly higher than T1. Their highest levels were at T2. They came down and reached pre-operative levels at T5. ②CK-MB, LDH and cTnI at T2, T3, T4 were significantly higher than T1. The highest level of CK-MB was at T2 and came back to pre-operative level at T5. The highest levels of LDH and cTnI were at T3 and they were still significantly higher at T5 than T1. ③Correlation analysis showed that CPB time was significantly related to IL-6, IL-8 at T2 and IL-8 at T3; IL-6 at T2 was significantly related to LDH and cTnI at T2; IL-8 at T2 was significantly related to CK-MB and LDH at T2; IL-8 at T2 and T3 were significantly related to mechanic ventilating time and ICU duration; TNF-α at T2 and T3 were significantly related to mechanic ventilating time and ICU duration. Conclusions Cardiopulmonary bypass induced systemic inflammatory response, lead to great releasing of proinflammatory cytokines. CPB time was significantly related to the concentration of proinflammatory cytokines and the degree of myocardial injury. The levels of proinflammatory cytokines are significantly related to post-operative recovery.

关 键 词：心脏瓣膜置换 围术期 炎性细胞因子 心肌损伤 

分 类 号：R654.2[医药卫生—外科学]