体外循环对单核细胞HLA-DR表达的影响  

The effect of cardiopulmonary bypass on monocyte HLA-DR expression

作　　者：方向明[1] 裘燕[1] 徐静[1] 王琦[2] 王永清[3] 陈自力[3] 郭继革[3] 王海宏[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院麻醉科,杭州市310016 [2]浙江大学邵逸夫临床医学研究所,杭州市310016 [3]浙江大学医学院附属邵逸夫医院心胸外科,杭州市310016

出　　处：《中华麻醉学杂志》2001年第7期399-402,共4页Chinese Journal of Anesthesiology

摘　　要：目的　研究体外循环对单核细胞表面HLA DR表达水平的影响。方法　 16例风湿性心脏病瓣膜置换术患者为试验组 (心内直视术组 ) ,10例肺叶切除术患者为对照组 (非心内直视术组 )。采用流式细胞术动态观察麻醉诱导前、气管插管后、体外循环心肺转流前、体外循环心肺转流后、手术后第 1d、第 3d及第 5d淋巴细胞和单核细胞表面HLA DR的表达水平 ,同时观察APACHEⅡ评分及手术后恢复情况。结果　心内直视术组心肺转流后、术后第 1d、第 3dHLA DR表达阳性的单核细胞百分率显著下降 ,且心肺转流后单核细胞数显著下降 ,单核细胞表面的HLA DR分子数显著下降 (P <0 0 5 )。肺叶切除术组手术后HLA DR表达阳性的单核细胞百分率明显下降 ,但单核细胞占外周血白细胞比例无显著性差异。HLA DR表达阳性的淋巴细胞百分率在各个时间点均无统计学差异 (P >0 0 5 ) ;两组相比 ,手术后HLA DR表达阳性的单核细胞百分率心内直视组显著低于肺叶切除组。 2例心内直视术后并发感染患者于术后第 6dHLA DR表达阳性的单核细胞百分率仍低于 4 0 %。结论　心肺转流后机体免疫功能的障碍与单核细胞的功能紧密相关。动态监测单核细胞表面HLAObjective The purpose of this study was to investigate the effects of cardiopulmonary bypass(CPB) on monocyte HLA DR expression and immune function Methods Sixteen ASA Ⅱ Ⅳ patients [mean age (38 5±5 1)yr,mean body weight (42 9±10 2kg)] of both sexes (male 7,female 9) with rheumatic value disease undergoing mitral value replacement (11 patients) and mitral value and aortic value replacement (5 patients) with moderate hypothermic CPB were enrolled in this study Another ten patients undergoing lung lobectomy were used as control group Patients suffering from infection, immuno deficiency or receiving corticosteroid or immunoregulatory drugs were excluded Premedication included intramusallar midazolam 0 1mg·kg -1 and morphine 0 1mg·kg -1 Anesthesia was induced with intravenous midazolam 0 15mg·kg -1 , fentanyl 8μg/kg and vecuronium 0 1mg·kg -1 and maintained with isoflurane inhalation (0 8%～1 2%) and intermittent boluses of fentanyl and vecuronium The total dose of fentanyl was (18 3±3 2)μg/kg in CPB group and (9 6±1 3)μg/kg in control group CPB time was (74 2±22 5) min and aortic clamping time (57 5±19 2) min Blood samples were taken from CVP line before and 5 min after induction of anesthesia, before and after CPB and on the 1st, 3rd and 5th postoperative day for determination monocyte count and percentage of HLA DR + monocytes Results The number of monocytes decreased at the end of surgery but greatly increased on the postoperative days The percentage of HLA DR + monocytes also decreased at the end of surgery and decreased further on the 1st postoperative day but started increasing on the 3rd postoperative day In two patients who developed infection the percentage of HLA DR + monoeytes was lower than the average percentage of HLA DR + monocytes of the other 14 CPB patients In control group the percentage of HLA DR + monocytes also decreased significantly after operation but there was no significant change in the number of

关 键 词：心肺转流术 单核细胞 HLA-DR抗原 体外循环 

分 类 号：R654.1[医药卫生—外科学]