血液灌流技术降低冠脉动脉旁路移植术联合心脏瓣膜置换术后并发症的对比研究  

Comparative study on reducing postoperative complications of cardiac valve replacement with coronary artery bypass grafting using blood perfusion technology

作　　者：付国伟[1] 李军[1] 赵俊杰[1] 孙欠欠 刘闯[1] 李杏杏 Fu Guowei;Li Jun;Zhao Junjie;Sun Qianqian;Liu Chuang;Li Xingxing(Department of Surgical Medicine,the First Afiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院外科医学部,郑州450000

出　　处：《中华实验外科杂志》2023年第5期961-964,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨血液灌流技术在冠脉动脉旁路移植术(CABG)联合心脏瓣膜置换体外循环(CPB)过程中是否能够有效吸附炎性细胞因子,从而降低体外循环相关急性肾损伤(CPB-AKI)发生率,改善预后。方法将2022年2月至2023年2月在郑州大学第一附属医院心血管外科行CABG联合心脏瓣膜置换的60例患者采用数字表法随机分为实验组和对照组,每组30例。使用血液灌流技术的患者为血液灌流(HP)组,不使用HA380的患者为对照组,根据纳入和排除标准确定56例患者(HP组30,对照组26)。分析术前、术中及术后白细胞、中性粒细胞、淋巴细胞、血肌酐、肾小球滤过率、白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子-α(TNF-α)结果,比较两组AKI发生率、重症监护室(ICU)住院时间、机械通气(MV)时间、术后住院时间和30天生存结局。应用SPSS22.0统计软件分析,应用Graphpad prism6.0软件进行作图。结果HP组TNF-α在术后0、6、24h均低于对照组[(1.98±0.96)pg/ml比(3.10±1.52)pg/ml,t=-3.261,P<0.05;(1.02±0.18)pg/ml比(2.68±0.81)pg/ml,t=-10.290,P<0.05;(1.07±0.67)pg/ml比(1.74±1.01)pg/ml,t=-2.893,P<0.05]。HP组术中IL-6[(4.40±0.94)pg/ml比(6.30±1.88)pg/ml,t=-4.668,P<0.05],术后IL-6(0h)[(111.00±54.55)pg/ml比(228.18±93.01)pg/ml;t=-5.638,P<0.05],术后IL-8(0、6、24h)[(44.60±11.15)pg/ml比(82.85±23.14)pg/ml,t=-7.690,P<0.05;(19.45±7.96)pg/ml比(25.49±12.39)pg/ml,t=-2.200,P<0.05;(13.85±5.53)pg/ml比(18.34±9.77)pg/ml,t=-2.073,P<0.05],术后IL-10(0、6、24 h)[(42.61±13.06)pg/ml比(84.95±23.17)pg/ml,t=-8.250,P<0.05;(5.91±3.91)pg/ml比(12.77±7.99)pg/ml,t=-3.989,P<0.05;(4.34±2.57)pg/ml比(7.06±4.61)pg/ml,t=-2.672,P<0.05]均低于对照组。HP组术后C反应蛋白(C-reactiveprotein,CRP)、中性粒细胞计数高于对照组[(83.73±50.47)ng/ml比(132.37±75.62)ng/ml,t=-2.785,P<0.05;(10.92±4.42)×10^(9)/L比(13.52±3.40)×10^(9)/L,t=-2.443,P<0.05],而术后淋巴细胞低于对照组[(0.61±0.35)×10^(9)/L比(0.40±0.19)×1Objective To investigate if blood perfusion technology is able to reduce the incidence of cardiopulmonary bypass-acute kidney injury(CPB-AKI)and improve prognosis by absorbing inflammato-ry cell factors in cardiopulmonary bypass(CPB)effectively for cardiac valve replacement with coronary artery bypass grafting(CABG).Methods Totally,60 patients undergoing cardiac valve replacement with CABG surgery were randomly enrolled in a single blind randomized controlled trial.A total of 56-six patients were determined based on inclusion and exclusion criteria.The patients were randomized into the haemoperfusion(HP)group(n=30)with blood perfusion technology in the CPB circuit or the control group(n=26)with the conventional CPB circuit.The results of leukocytes,neutrophils,lymphocytes,serum creatinine,glomerular filtration rate,interleukin-6(IL-6),IL-8,IL-10 and tumor necrosis factor-α(TNF-α)were analyzed preoperatively,intraoperatively and postoperatively.The graphs were performed using Graphpad prism 6.O software.Results TNF-αin the HP group was lower than that in the control group at 0 h,6 h and 24 h after surgery[(1.98±0.96)vs.(3.10±1.52)pg/ml;(1.02±0.18)vs.(2.68±0.81)pg/ml;(1.07±0.67)vs.(1.74±1.01)pg/ml,t=-3.261,P<0.05,t=-10.290,P<0.05,t=-2.893,P<0.05].Intraoperative IL-6[(4.40±0.94)vs.(6.30±1.88)pg/ml,t=-4.668,P<0.05],postoperative IL-6(0 h)[(111.00±54.55)vs.(228.18±93.01)pg/ml,t=-5.638,P<0.05],postoperative IL-8(0,6,24 h)[(44.60±11.15)vs.(82.85±23.14)pg/ml,t=-7.690,P<0.05;(19.45±7.96)vs.(25.49±12.39)pg/ml,t=-2.200,P<0.05;(13.85±5.53)vs.(18.34±9.77)pg/ml,t=-2.073,P<0.05]and postoperative IL-10(0,6,24 h)[(42.61±13.06)vs.(84.95±23.17)pg/ml,t=-8.250,P<0.05;(5.91±3.91)vs.(12.77±7.99)pg/ml,t=-3.989,P<0.05;(4.34±2.57)vs.(7.06±4.61)pg/ml,t=-2.672,P<0.05] were lower in the HP group than those in the control group.The postoperative C-reactive protein(CRP)and neutrophil counts in the HP group were increased as compared with those in the control group[(83.73±50.47)vs.(132.37±75.62)ng/ml,t=-2.785,P<0.05;(

关 键 词：冠状动脉旁路移植术 心脏瓣膜置换 HA380 急性肾损伤 

分 类 号：R654.2[医药卫生—外科学]