自体肺与人工肺体外循环对全身炎症反应的对比研究  

Comparative study of the effect between autogenous oxygenator CPB and artificial oxygenator CPB on SIR

作　　者：张永恒[1] 向小勇[2] 

机构地区：[1]四川省遂宁市人民医院胸心外科,四川遂宁629000 [2]重庆医科大学第一附属医院胸心外科

出　　处：《中国医师杂志》2007年第12期1593-1596,共4页Journal of Chinese Physician

摘　　要：目的探讨自体肺体外循环与人工肺体外循环对全身炎症反应（SIR）的影响。方法选择健康杂种犬12只，体重（13±1）kg，随机分为自体肺组和人工肺组，每组6只。实验组为自体肺组，利用杂种犬自体肺作为氧合器。对照组为人工肺组，常规体外循环组，利用鼓泡肺作为氧合器。2组采用相同的心肌保护、心脏停跳方法。2组体外循环均持续1h，于体外循环前、体外循环开始30min、停机后5min、60min、2h、4h取血标本进行白细胞和血小板计数，用ELISA法测定血浆中IL-6、IL-8及TNF-α水平。结果转流开始后，各组中性粒细胞明显高于转流前（P〈0.05），血小板呈消耗性下降（P〈0.05），对照组在转流后不同时点明显低于实验组（P〈0.05）；转流后各组血浆中IL-6、IL-8及TNF-α水平均明显高于基础值（P〈0.05），其中对照组在不同时点明显高于实验组（P〈0.05）。结论人工肺的非生理界面是体外循环术后SIR的主要诱因，自体肺体外循环技术从多个环节上抑制体外循环炎症反应。Objective To study the effect between autogenous oxygenator CPB and artificial oxygentor CPB on SIRS. Methods 12 adult mongrel dogs （weight 13 ± 1kg） were random divided into two groups： 6 dogs for experimental group in which the dog＇s own lung was used as oxygenator, 6 dogs for control group in which the artificial lung （bubble oxygenator） was used as oxygenator. The technique of myocardium protection and cardiac arrest were used in two groups. CPB was controlled to run for 1 hour in both groups. The blood samples were collected at the same time point of preoperation, 30min of aortic on - clamping, and 5min, 60min, 1 hour, 2hour, 4hour of post aortic off - clamping. The neutrophil count, platelet count were measured. Plasma concentration of IL-6, IL-8, TNF-α was detected with ELISA. Resuits After running of CPB, platelet count decreased at different time point and the number of platelet count were significantly higher in the experimental groups, compared with those in the control groups（ P 〈 0. 05 ）. The PMN and plasma levels of IL-6, IL-8, TNF-α significantly increased at different time point in the control group, compared with those in the experimental group （ P 〈0. 05）. However, these parameters were significantly higher in two groups than that before CPB. Conclusion The foreign body surface of artificial lung is the main induced factor of the SIR during CPB. The autogenous oxygenator CPB technique could inhibit inflammatory response in multiple aspects.

关 键 词：体外循环 肺 人工器官 多器官功能衰竭 脓毒症综合征 

分 类 号：R65[医药卫生—外科学]