探讨深低温停循环患者围术期血浆白细胞介素-6动态变化与复苏延迟的关系  

To investigate the relationship between deep hypothermic in plasma IL- 6 dynamic change and resuscitation phase delay loop patients

作　　者：刘畅[1] 薛云星[1] 徐贞俊[1] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京21000

出　　处：《中国体外循环杂志》2015年第1期21-24,64,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的观察深低温停循环(DHCA)与DHCA+选择性脑灌注(ASCP)患者围术期白细胞介素-6(IL-6)水平的变化规律及其与复苏延迟的相关性。方法选择24例DHCA手术患者,分别于体外循环(ECC)前、DHCA前、DHCA后、术后24 h、48 h,五个时间点用ELISA法检测IL-6的浓度。按照术后24 h内清醒分为正常复苏组(A组)、复苏延迟组(B组)、DHCA组(C组)、DHCA+ASCP组(D组)。用Pearson相关分析法进行相关分析。结果全组患者术后死亡2例,其余痊愈出院。ECC后各个时间点的IL-6浓度较ECC前有升高趋势,但差异没有显著性(P>0.05)。IL-6血浆水平随ECC的进行而逐渐升高,直至DHCA后达到峰值,至术后48 h表现为逐渐下降的趋势。IL-6血浆水平在术后24 h与ECC时间、升主动脉阻断(ACC)时间及DHCA时间呈正相关趋势,但无统计学意义(P>0.05)。B组患者各时间点的血浆IL-6水平的上升较A组更加明显(P<0.05)。C组患者术后24 h,IL-6上升较D组明显但没有显著性差异(P>0.05)。结论深低温ECC可以引起全身炎症反应综合征的发生;DHCA+ASCP对降低DHCA过程中炎症反应的作用较单纯应用DHCA要优越;血浆IL-6水平的上升加重炎症反应与术后苏醒延迟之间存在一定的相关性;ECC时间、ACC时间、DHCA时间的长短均影响血浆IL-6的释放,可能影响到术后患者复苏延迟及炎性反应的程度。术后48 h内采取有效的抗炎症治疗可能对患者更有益处。Objective To observe deep hypothermia during extracorporeal circulation（ ECC） in the cardiac surgery,including deep hypothermic circulatory arrest（ DHCA） subgroup and DHCA with selective cerebral perfusion（ DHCA＋ASCP） subgroup. Methods 24 cases of patients with DHCA operation,respectively in pre- ECC,pre-DHCA,post-DHCA,24 hours and 48 hours of post-operation. Group A as wakeup during the 24 hours post operation and Group B as delayed recovery more than 24 hours. We grouped all cases into Group A as DHCA only and Group B as DHCA with ASCP. Results Two cases died in all patients,the others were cured. The concentration of IL-6 at different time points after ECC than before ECC has a rising trend,but the difference was not significant（ P〉0. 05）. IL-6 plasma levels with ECC were gradually increased until it reached a peak after DHCA,until after 48 h showed a gradual downward trend. The serum levels of IL-6 were positive correlation with the time of ECC,aortic clamping（ ACC） and DHCA.The results of subgroups showed that the IL-6 of Group B was increasing more obviously than Group A（ P〈0. 05）. The level of IL-6 in Group C in the time point of 24 hours post-operation was increasing more obviously than Group D,but the difference was not statistically significant（ P〉0. 05）. Conclusion Deep hypothermic ECC can cause systemic inflammatory response syndrome occurred; DHCA＋ASCP to reduce the inflammatory reaction in the process of role than the simple application of DHCA to the superior; The rise in plasma IL-6 levels increase the inflammatory response and post-operative delayed recovery exist between certain correlation; Length of ECC,ACC and DHCA time influence the plasma IL-6 release,may affect the post-operative patients with fluid resuscitation and inflammatory reaction degree. Take effective anti-inflammatory treatment may benefit to patients with more 48 hours after operation.

关 键 词：深低温停循环 白细胞介素-6 选择性脑灌注 全身炎症反应综合征 

分 类 号：R654.1[医药卫生—外科学]