库存悬浮红细胞不同预处理对婴幼儿体外循环后炎性反应的影响  

Influence of different treatment with banked suspended red blood cells on the inflammatory response after cardiopulmonary bypass in infants

作　　者：杨玉齐[1] 徐红亮[1] 范顺阳[1] 尉新华[1] 张金涛[1] 徐云飞[1] 李群[1] 

机构地区：[1]郑州大学第三附属医院心脏中心,河南省九心病诊疗中心,450052

出　　处：《中华实用儿科临床杂志》2015年第23期1788-1791,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的观察库存悬浮红细胞应用血液回收机洗涤及零平衡超滤2种不同方法预处理后预充财婴幼儿体外循环后炎性反应的影响。方法选取室间隔缺损择期手术患儿60例，按随机数字表法分成A组（对照组）、B组和c组，各20例。A组对体外循环预充用库存悬浮红细胞不进行任何预处理，B组应用血液回收机对库存悬浮红细胞进行洗涤处理后再预充，C组对库存悬浮红细胞进行体外循环前零平衡超滤。分别在体外循环开始前、体外循环结束时、术后2h、术后12h、术后24h取动脉血标本行肿瘤坏死因子-α（TNF-α、白细胞介素（IL）-6、IL-8、IL-10检测，比较3组之间的差异。结果3组患儿的血TNF-α、IL-6、IL-8、IL-10在体外循环结束时、术后2h、术后12h均呈持续升高趋势，在术后12h达到较高水平，A、B、C3组分别为：（110．3±14．0）×10^-9／L、（90．6±10．3）×10^-9／L、（103．3±9．7）×10^-9／L；（54．1±6．5）×10^-9／L、（39．3±4．2）×10^-9／L、（46．2±5．7）×10^-9／L；（96．8±9．2）×10^-9／L、（82．5±6．5）×10^-9／L、（88．4±5．1）×10^-9／L；（228．4±42．9）×10^-9／L、（171．5±26．4）×10^-9／L、（202．9±42．8）×10^-9／L，此趋势在术后24h降至略高于术前水平；TNF-α、IL-8在术后整个过程B组、C组均显著低于A组（P均〈0．05）；IL-6、IL-10在术后24h时B组、C组和A组差异无统计学意义（P〉0．05）；TNF-α、IL-6、IL-8、IL-10在循环结束时、术后2h、术后12hB组显著低于C组（P均〈0．05）。结论应用血液回收机洗涤和零平衡超滤对婴幼儿体外循环预充用库存悬浮红细胞进行预处理，均可减轻体外循环后炎性反应，相比较而言，血液回收机洗涤处理的效果更好。Objective To compare the influence of washing processed of banked suspended red blood cells （RBCs） by cell saver and the influence by zero -balanced ultrafihration（ Z -BUF） on the inflammatory response after cardiopulmonary bypass （CPB） in infants. Methods Sixty infants with ventricular septal defect （VSD） were randomly divided into a control group （group A,20 cases） , group B （20 cases）and group C （20 cases）. Banked suspended RBCs were washed by cell saver before priming in group B,in group C the banked suspended RBCs were treated with Z - BUF and in group C the banked suspended RBCs were primed directly without any pre - treatment. Samples of the arterial blood were obtained respectively before the start of the CPB （T1） ,when the CPB stopped（T2） ,2 h after CPB （T3） , 12 h after CPB （T4） and 24 h after CPB （ T5 ）. The levels of tumor necrosis factor-α （ TNF -α） , interleukin （IL） - 6, IL - 8,IL - 10 were detected and analyzed comparatively among 3 groups. Results The levels of TNF-α, IL - 6, IL - 8, IL - 10 in 3 groups at T2,T3,T4 showed a rising trend markedly,and the above four indicators of A, B and C at T4respectivelywere：（110.3±14.0）×10^-9/L,（90.6±10.3） ×10^-9/L,（103.3±9.7） ×10^-9/L;（54.1 ±6.5）×10^-9 /L,（39.3 ±4.2）×10^-9/L,（46.2±5.7） ×10^-9/L;（96.8±9.2） ×10^-9/L,（82.5±6.5）×10^-9/L,（88.4±5.1） ×10^-9/L;（228.4±42.9）×10^-9/L,（171.5±26.4）×10^-9/L,（202.9±42.8） ×10^-9/L. The levels of TNF -α and IL - 8 in group B and group C were significantly lower than those in group A at T2, T3,T4 and T5（all P 〈0.05） ,but there was no significant differences in the levels of IL-6 and IL- 10 among 3 groups at T5 ; the levels of TNF - α, IL - 6, IL - 8, IL - 10 in group B were significantly lower than those in group C at T2, T3 and T4 （ all P 〈 0.05 ）. Conclusions Processing of banked suspended pre - RBCs with cell saver and Z - BUF can relieve systemic inflammatory response, and the e

关 键 词：悬浮红细胞 血液回收机 零平衡超滤 体外循环 炎性反应 

分 类 号：R726.5[医药卫生—儿科]