心内直视术患者围术期血清TNF-α水平动态变化及其临床意义  

Perioperative Changes of Tumor Necrosis Factor Alpha and Its Action in Patients Undergoing Cardiopulmonary Bypass

作　　者：罗爱林[1] 田玉科[1] 金士翱[1] 

机构地区：[1]同济医科大学附属同济医院麻醉教研室

出　　处：《临床麻醉学杂志》1998年第1期5-7,共3页Journal of Clinical Anesthesiology

基　　金：国家教委资助

摘　　要：目的与方法：观察了４０例择期心内手术患者及３０例普外择期手术患者围术期血清ＴＮＦ－α水平变化。结果：心内手术后２周内患者细胞免疫和红细胞免疫功能被明显抑制，而血清肿瘤坏死因子ＴＮＦ－α明显升高，若合并严重感染后则进一步升高，但普外手术组上述参数变化与术前相比无统计学意义。心内手术术后严重感染率３３％，ＭＳＯＦ发生率７．５％，而血清ＴＮＦ－α水平与感染性并发症发生率呈正相关（Ｐ＜０．０１），普外手术组术后严重感染率仅６％。结论：心内手术后患者严重的细胞和红细胞免疫功能障碍是导致严重感染的最直接原因之一，而严重感染者血清ＴＮＦ－α水平急剧升高是引发ＭＳＯＦ的机理之一。bjective and Methods:A comparative study between the patients scheduled for cardiopulmonary bapass (CPB) and those underwent selective general surgary was carried out.Results: Experimenmtal data show that cell mediated and erythrocytic immunity were both siginificantly inhibited within two weeks after CPB,which was accompanied with a sharp rise of blood level of tumor necrosis factor alpha(TNF).The concentration of TNF alpha was increased to the highest level if the patient was complicated by severe infection.On the contrary,no statisical difference was discovered between preand postoperative values of the parameters mentioned above in general surgery group after operation.Serious infectious rate of 325%,morbility of multiple system organ failure(MSOF) of 75%,and a linear regression between serum level of TNF alpha and incidence of severe infection were observed in CPB group.Conversely,in general surgery group serious infection rate was only 6%.Conclusion:It is concluded that serious cellular and erythrocytic immunodepression is the direct reason for resulting in severe infection after CPB,and a high level of TNF alpha in serum is one of the mechanisms of MSOF.

关 键 词：肿瘤坏死因子 心脏外科手术 围手术期 

分 类 号：R654.205[医药卫生—外科学]