零平衡超滤对体外循环瓣膜置换术患者白细胞介素-6、白细胞介素-10和高敏C-反应蛋白的影响  

Effect of zero-balanced ultrafiltration on interleukin-6,interleukin-10 and high sensitivity C-reactive protein in patients received valve replacement under cardiopulmonary bypass

作　　者：罗荣 陈枝[1] 张伟强[1] 张岳农[1] LUO Rong;CHEN Zhi;ZHANG Wei-qiang;ZHANG Yue-nong(Department of Anesthesiology,Meizhou City People＇s Hospital,Meizhou,Guangdong 514021,China)

机构地区：[1]梅州市人民医院麻醉一科,广东梅州514021

出　　处：《岭南心血管病杂志》2018年第5期556-560,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探究体外循环(cardiopulmonary bypass,CPB)下零平衡超滤对心脏瓣膜置换术患者促炎因子白细胞介素(interleukin,IL)-6、IL-10和高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)浓度的影响。方法选取2015年1月至2017年1月梅州市人民医院收治的CPB心脏瓣膜置换术患者40例,按随机数字表法分为观察组(n=20,零平衡超滤组)和对照组(n=20,常规超滤组),分别于CPB前(T_1)、超滤毕即刻(T_2)、术后24 h(T_3)、48 h(T_4)、72 h(T_5)时间点采集动脉血标本,采用双抗体夹心酶联免疫吸附法(ELISA)法测定血浆中IL-6和IL-10浓度,免疫比浊法测定血浆hs-CRP浓度。收集患者术前和术后的临床资料。结果两组患者基线资料比较,差异无统计学意义(P>0.05);两组患者术中的临床指标比较,差异无统计学意义(P>0.05);两组患者术前IL-6、IL-10和hs-CRP浓度均在正常范围,组间比较差异无统计学意义(P>0.05);两组患者的IL-6浓度于CPB开始后均有显著升高,术后24 h时均达到峰值,术后72 h仍高于术前,差异均有统计学意义(P<0.01);且观察组在T_3、T_4、T_5时刻IL-6浓度均显著低于对照组,差异均有统计学意义(P<0.05)。两组患者的IL-10浓度术后即刻均显著升高,术后24 h均达到峰值,术后72 h仍高于术前,差异均有统计学意义(P<0.01);观察组的IL-10浓度在T_2、T_3、T_4、T_5时刻均低于对照组,但差异无统计学意义(P>0.05)。两组患者的血浆hs-CRP浓度于CPB开始后均缓慢升高,术后48 h均达到峰值,术后72 h仍高于术前,差异均有统计学意义(P<0.01);且观察组血浆hs-CRP浓度在T_3、T_4、T_5时刻均显著低于对照组,差异均有统计学意义(P<0.05)。结论 CPB瓣膜置换术中患者血液IL-6、IL-10和hs-CRP浓度会产生明显变化。零平衡超滤能有效降低术后炎症反应,减少机体损伤,改善临床预后,值得临床推广应用。Objectives To explore the effect of zero-balanced ultrafiltration on intertleukin （IL）-6, IL-10 and high sensitivity C-reactive protein （hs-CRP） in patients received valve replacement under cardiopuhnonary bypass （CPB）. Methods Forty patients received heart valve replacement surgery under CPB in Meizhou City People＇s Hospital from January 2015 to January 2017 were randomly divided into control group （conventional ultrafiltration, n=20）and observation group （zero-balanced ultrafiltration, n=20）. Arterial blood samples were collected at several time points in the two groups： before CPB （T,）, after ultrafiltration immediately （%） and 24 h（%） , 48 h（%）, 72 h（Ts） after surgery. Concentrations of IL-6 and IL-10 were tested by enzyme linked immunosorbent assay （ELISA）. Concentration of hs- CRP was tested by immunoturbidimetry. Pre-and-post-operative clinical data were also collected. Results There were no significant differences between the two groups in basic and clinical data （P〉0.05）. Concentrations of IL-6, IL-10 and hs-CRP were in normal range in the two groups before surgery, and there were no significant differences of them between the two groups （P〉0.05）. Concentration of IL-6 began to significantly increase after CPB in the two groups and reached its peak at T3, which was still significantly higher than those at T, after 72 h （P〈0.01）. Concentrations of IL-6 in observation group were significantly lower than those in control group at T3, T4 and Ts （P〈0.05）. Concentration of IL-10 began to significantly increase after surgery and reached its peak at T3, which was still significantly higher than that at T1 after 72 h （P〈0.01）. Concentrations of IL-10 in observation group were significantly lower than those in control group at %, %, T4 and % （P〈0.05）. Concentration of hs-CRP began to slowly increase after CPB and reached its peak at T4, which was still higher than that at T1 after 72 h （P〈0.01）. Concentration of hs-CRP in obs

关 键 词：零平衡超滤 体外循环 瓣膜置换术 细胞因子 高敏C-反应蛋白 

分 类 号：R654.2[医药卫生—外科学]