白细胞滤器在体外循环中对犬肾脏的影响  

Effects of leukocyte depletion filter on canine kidney during cardiopulmonary bypass

作　　者：杨亦彬[1] 朱昭琼[1] 郑洪[2] 杜磊[3] 黄颂敏[1] 

机构地区：[1]四川大学华西医院肾内科,成都610041 [2]遵义医学院附属医院肾内科,贵州遵义563003 [3]四川大学华西医院麻醉科,成都610041

出　　处：《中南大学学报（医学版）》2005年第3期321-324,共4页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金青年基金(30400439)

摘　　要：目的:探讨体外循环(CPB)中加用白细胞滤器(LDF1)对犬肾脏的影响。方法:12只犬随机均分为对照组(不使用LDF1)和实验组(静脉回流端置LDF1)。全身麻醉建立CPB,并于CPB10min后阻断升主动脉,经主动脉根部灌注St.Thomas液,70min后开放升主动脉并停机后观察2h,其中实验组于CPB2min后开放LDF1,过滤5min后停止。分别于不同时间点观察血白细胞数、L选择素、IL8、肾功能以及尿常规,同时行肾脏组织病理学检查。结果:实验组于CPB期间白细胞数下降55%～68%,CPB10min时明显低于对照组(P<0.05);停CPB2h后实验组L选择素和IL8亦明显低于对照组(P<0.05),而2组血尿素和肌酐无明显差异(P>0.05),但尿均出现明显红细胞;2组肾小管均呈现不同程度肿胀,对照组2例、实验组1例小管细胞空泡变性,肾小球无明显改变。结论:白细胞滤器能有效去除CPB中活化白细胞、减轻炎性反应,但单纯加用白细胞滤器不能发挥显著的肾脏保护作用,应注重CPB术后的肾脏保护。Objective To explore the effect of a reforming leukocyte depletion filter (LDF-1) on the functional and pathologic changes of canine kidney during cardiopulmonary bypass (CPB). Methods Twelve Mongolian dogs were randomly allocated into a control group (no LDF-1, n=6) or a leukocyte-depleted filter group (LDF-1 placed in venous line,n=6).CPB of the dogs anestheitized with sodium pentobarbitone at 25mg/kg was set up. After 10min of CPB, aorta was clamped and St.Thomas cardioplegic solution at 20mg/kg was immediately injected into the root of aorta. The aortic cross-clamp was released and CPB was closed at 70min. Dogs were observed for 2h after weaning from CPB. LDF-1 was opened at 2min and stoped at 7min during initially running CPB in the LDF-1 group. Circulating leukocytes, plasma L-selectin,and plasma IL-8 were respectively counted before CPB, at 10 minutes, 40min, and 75min during CPB, the end of CPB, and 2h after CPB. The urine analysis and renal pathology, which were obtained before CPB and 2h after CPB, were observed. Results The number of leukocytes significantly decreased by 55%～68% in the LDF-1 group compared with the baseline during CPB. The value at 10min of CPB in the LDF-1 group was lower than that in the control group (P< 0.05). Plasma levels of L-selectin and IL-8 obviously increased in the 2 groups compared with the baseline during CPB, but both levels at 2h after CPB in the LDF-1 group were lower than those in the control group (P< 0.05). No statistic difference was found in plasma levels of urea and creatinine, but hematuria was observed in the 2 groups at 2 hours after CPB. The pathologic changes of kidney, which was mainly renal tubule swelling accompanied partly with vacuolar degeneration, were similar under the light microscope in the 2 groups at 2h after CPB. Obvious glomerular damage was not found. Conclusion LDF-1 can effectively decrease leukocyte counts and the inflammatory reaction ,but it can not bring about excellent protective effect on kid

关 键 词：体外循环 白细胞滤器 炎性反应 肾脏 

分 类 号：R654.2[医药卫生—外科学]