两种氧合器对心肺转流炎症反应的影响  

The effect of different oxygenators on inflammatory response during cardiopulmonary bypass

作　　者：曲振华[1] 李国艳[2] 赵砚丽[2] 刘志军[3] 马洪亮[4] 

机构地区：[1]河北省邢台市人民医院麻醉科,054031 [2]河北省人民医院麻醉科 [3]河北医科大学第二附属医院麻醉科 [4]河北医科大学第四附属医院

出　　处：《临床麻醉学杂志》2006年第9期649-651,共3页Journal of Clinical Anesthesiology

基　　金：2005年河北省科学技术研究与发展计划项目(052761294)

摘　　要：目的动态监测室间隔缺损修补术患者在心肺转流(CPB)各时段血清可溶性细胞间粘附分子(sICAM-1)、可溶性E-选择素(sE-selection)及肿瘤坏死因子α(TNF-α)的变化规律,并比较西京-90鼓泡式氧合器和希健-Ⅱ膜式氧合器对其的影响。方法选择择期行室间隔缺损修补术的患者30例,随机均分为鼓泡式氧合器组(B组)和膜式氧合器组(M组)。所有患者分别在麻醉后CPB开始前(T1)、主动脉阻断开放前(T2)、CPB结束时(T3)、术后2h(T4)、6h(T5)、24h(T6)及48h(T7)取静脉血5ml用ELISA法测定sICAM-1、sE-selection及TNF-α的浓度。结果两组患者血清中的TNF-α于T2时开始显著升高,T4时达到峰值(P<0·01)。sICAM-1于T5时开始升高,T6时达峰值。sE-selection于T4时开始升高,T5时达峰值(P<0·01)。M组大部分时点TNF-α、sICAM-1、sE-selection的浓度均低于B组。结论希健-Ⅱ膜式氧合器引起的炎症反应较轻。Objective To evaluate the effect of bubble and membrane oxygenators on inflammatory response during cardiopulmonary bypass（CPB）. Methods Thirty patients were divided into two groups with 15 cases each： group B （bubble oxygenator）, group M （membrane oxygenator）. Blood samples were taken before CPB（T1 ）,before aortic unclamping（T2 ）,at the end of CPB（T3 ）, 2 hours after operation（T4 ）, 6 hours after operation （ T5 ）, 24 hours after operation （ T6 ） and 48 hours after operation（T7 ）, for measuring the concentrations of sICAM-1, sE-selection and TNF-α by ELISA. Results Compared to the baseline,the serum TNF-α increased significantly at T2 and reached at the peak level at T4 （P〈0.01）, sICAM-1 increased at T5 and reached at the peak level at T6 ,and sE-selectin increased markedly at T4 and reached at the peak level at T5 （P〈0.01） in both groups. The serum levels of TNF-α,sICAM-1 and sE-selectin were higher in group B than those in group M at most time points. Conclusion The inflammatory response was less with xijian-Ⅱ membrane oxygenator than that with xijing-90 bubble oxygenator.

关 键 词：心肺转流 炎症反应 膜式氧合器 鼓泡式氧合器 

分 类 号：R614[医药卫生—麻醉学]