改良超滤联合平衡超滤对婴幼儿体外循环术后IL-6,TNF-α及sICAM-1血浆含量和肺功能影响  

Effects of balanced ultrafiltration combined with modified ultrafiltration technique on plasma level of IL-6,TNF-α,sICAM-1 and pulmonary function in infant open heart surgery

作　　者：马黎明[1] 褚衍林[1] 乔衍礼[1] 武广华[1] 李平萍[1] 张来柱[1] 刘宏生[1] 程前进[1] 李祥[1] 张洪宇[1] 孙卓祥[2] 董海新[2] 

机构地区：[1]山东省医药卫生重点学科心血管疾病研究诊治中心济宁医学院附院心脏外科,270029 [2]山东省医药卫生重点学科心血管疾病研究诊治中心济宁医学院附院检验科,270029

出　　处：《心肺血管病杂志》2011年第1期13-16,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨婴幼儿体外循环(CPB)术后肺损害机理及平衡超滤联合改良超滤对其肺功能保护效果。方法:60例先天性心脏病患儿随机分为对照组(C)、改良超滤组(M)和平衡超滤联合改良超滤组(U)。M组在转流结束后应用改良超滤,U组在转流开始后进行平衡超滤,转流结束后进行改良超滤。分别在转流前(T1),转流结束后20 min(T2),术后2 h(T3),术后6 h(T4),术后12 h(T5)和术后24h(T6)测定记录气道峰压(Ppeak)、呼吸停顿压(Ppause)、潮气量(TV)、呼吸频率(F)、吸入氧浓度(FiO2)和吸气比例(insp)并测量动脉血中白介素6(IL-6)、肿瘤坏死因子(TNF-α)及黏附因子(sICAM-1)的浓度。结果:各组CPB术后较术前的肺静态顺应性(Cstat)、氧合指数(OI)明显降低,肺泡一动脉氧分压(AaD02)明显增加,在T4、T5时间U组的Cstat、OI明显高于M组和C组,M组高于C组;AaDO2明显低于M组和C组,M组低于C组。IL-6、TNF-α,及sICAM-1术后浓度均明显升高,sICAM-1浓度高峰较迟。在T2、T3、T4及T5时间,U组的IL-6、TNF-α及sICAM-1浓度明显低于M组和C组。结论:术后肺功能损害可能与CPB术后大量炎性细胞因子释放及黏附因子合成与分泌导致肺毛细血管内皮损伤有关。联合应用平衡超滤和改良超滤可降低血浆中的炎性因子的浓度,减轻炎性反应,改善患儿肺的通气功能和换气功能,具有良好肺保护作用。Objective：To study the mechanism of pulmonary injury and the effect of balanced ultrafil-tration with modified ultrafiltration on pulmonary function in infant open heart surgery.Methods：60 cases of congenita1 heart disease were divided into contro1 group（C）,modified ultrafiltration group（M）and balanced ultrafiltration with modified ultrafihration group（U）.The cardiopulmonary bypass（CPB） was used with modi-fied ultrafiltration in Group M and balanced ultrafiltration with modified ultrafiltration in Group U.The pneumo-dynamic parameters and inflammatory mediators were measured at specific time points.Results：The static pul-monary compliance（Cstat） and oxygen index（OI） were lower,and alveolar-arteria oxygen difference（Aa-DO2） was higher after CPB in the three groups.At T4 and T5 time points,the Cstat and O1 in Group U was higher than that in the Groups M and C,and that in Group M was higher than in Group C;AaDO2 in Group U was lower than that in the Groups M and C,but that in Group M was lower than in Group C.The 1eves of IL-6 TNF-α and sICAM-1 were higher after CPB in the three groups;however,the leve1s of IL-6,TNF-α and sI-CAM-1 in Group U were lowe than that in Groups M and C at T2,T3,T4 and T5 time points.Conclusion：The pulmonary injury in pediatric open heart surgery may be concerned with the endothelial damage of pulmonary capillaries due to the cytokine releasing and increased synthesis and secretion of cell adhesion olecules.There-fore,combined balanced ultrafiltration with modified ultrafiltration degrades plasma concentrations of IL-6,TNF-α,and sICAM-1,and improves pulmonary ventilation and air exchange function.

关 键 词：先天性心脏病 超滤 体外循环 肺功能 婴幼儿 

分 类 号：R541.1[医药卫生—心血管疾病]