心脏手术中细胞因子和酸碱、血气的变化  

The Alterations of Cytokins, Blood Gas Tension and Acid-base during Cardiac Surgery under Extracorporeal Circulation

作　　者：王力甚[1] 倪蓉[2] 王年云[1] 李圣平[1] 李芳[1] 向强[1] 倪娟 

机构地区：[1]华中科技大学同济医学院附属荆州医院麻醉科 [2]华中科技大学同济医学院附属荆州医院检验部核医学科 [3]荆州市胸科医院麻醉科,湖北荆州434020

出　　处：《中国体外循环杂志》2005年第1期14-16,19,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的　研究体外循环(CPB)下心脏直视手术中细胞因子的变化。方法　选择ASAI^II级先天性房、室间隔缺损修补病人 25例,术前一般情况良好。以咪唑安定、芬太尼和维库溴铵快速诱导插管,安氟烷、芬太尼和维库溴铵维持麻醉。在手术前、转流后、复跳后、停机后及术毕从中心静脉抽取血样,用于检测白细胞介素(IL)IL-1β、IL-6、IL-8及肿瘤坏死因子(TNF-α)的浓度。同时检测电解质、酸碱和静脉血气的变化。结果　与术前相比,所有细胞因子均呈现上升趋势。IL-1β在复跳后至术毕明显升高(P<0. 01),IL-6和IL-8在转流前即开始明显上升,直到术毕(P<0. 05)。TNF-α从转流前开始上升,但直到术毕才有显著意义 (P<0. 01)。K+在复跳和停机后明显升高(P<0. 05),但仍在正常范围内;pH、碳酸氢根 (HCO3- )、硷剩余 (BE)、二氧化碳总量(TCO2 )和血尿素氮(BUN)无明显变化(P>0. 05),静脉二氧化碳分压 (PCO2 )在术毕明显升高 (P<0. 05);红细胞压积(Hct)在转流后至术毕均明显降低(P<0. 01)。结论　CPB中血液酸碱度、血气和电解质基本稳定,但细胞因子明显升高。OBJECTIVE To study the alterations of cytokins, blood gas tension, acid-base balance and electrolytes during cardiac surgery under extracorporeal circulation.METHODS 25 cases of patients with ASD or VSD were randomly chosen for repairtive surgery. The patients were induced and intubated with midazolam, fentanyl and vecurium. The anesthesia was maintained with intermittent vecurium, enfluane and fentanyl. Blood samples were drawn from the CVP tube at time intervals: before operation, following CPB, heart re-beating, cessation of CPB and at the end of the operation. The levels of IL-1β、IL-6、IL-8 and TNF-α were analyzed by radioimmunoassay. Venous blood gas tension, acid-base and electrolytes were also measured with i-stat analyzer.RESULTS Compared with preoperative values, all the cytokins were prone to elevate. Potassium rose significantly within normal range following rebeating and cessation of CPB(P<0.05). There were no significant differences in pH、HCO 3-、BE、TCO 2 and BUN(P>0.05). PCO 2 significantly increased at the end of the operation. HCT significantly increased following CPB till the end of the operation(P<0.01).CONCLUSION Blood gas tension, acid-base balance and electrolytes remain stable, but the cytokins increase significantly during cardiac surgery under extracorporeal circulation.

关 键 词：转流 血气 细胞因子 升高 术中 IL-8 心脏手术 IL-1Β 维库溴铵 IL-6 

分 类 号：R654.2[医药卫生—外科学]