摘要
目的:探讨婴幼儿体外循环术后心肌损害机理及平衡超滤联合改良超滤对心肌保护效果。方法:60例先天性心脏病患儿随机分为对照组(C)、改良超滤组(M)和平衡超滤联合改良超滤组(U)。M组在转流结束后应用改良超滤,U组在转流开始后进行平衡超滤,转流结束后进行改良超滤。分别在转流前(T1)、转流结束后20min(T2)、术后2h(T3)、术后6h(T4)、术后12h(T5)和术后24h(T6)测量动脉血中白介素6(IL-6)、肿瘤坏死因子(TNF-α)、黏附因子(sICAM-1)及丙二醛(MDA)、超氧化物歧化酶(SOD)、磷酸激酶同工酶(CK-MB)、肌酐蛋白(CTn-1)、脑利钠肽(BNP)的浓度。结果:IL-6、TNF-α及sICAM-1体外循环术后浓度三组均明显升高,U组的IL-6、TNF-α及sICAM-1浓度明显低于M组和C组。SOD体外循环术后浓度三组均降低,U和M组较C组降低明显;MDA体外循环术后浓度C和M组增高,U组无明显增高;CTn-1、CK-MB体外循环术后血浆浓度三组均较术前增高,U和M组较C组增高明显;BNP体外循环术后血浆浓度U和M组较术前明显降低,U组和M组明显低于C组。结论:婴幼儿体外循环术后心肌损害可能与大量炎性细胞因子释放及心肌再灌注损伤有关。联合应用平衡超滤和改良超滤可降低血浆中的炎性因子及脑利钠肽的浓度,对减轻心脏负荷、改善心脏功能有一定作用,但无明显减轻心肌急性损伤作用。
Objective： To study the mechanism of myocardial ischemic and reperfusion injury and the effect of balanced ultrafiltration with modified ultrafiltration on myocardial protection in infant open heart surgery. Methods： 60 cases of congenital heart disease were divided into control group（C） ,modified ultrafiltration group（M）and balanced ultrafiltra- tion with modified ultrafihration group（U）. The cardiopulmonary bypass（CPB）was used with modified ultrafiltration in Group M and balanced ultrafiltration with modified ultrafiltration in Group U. The inflammatory mediators and MDA. SOD, CK-MB.CTn-1 .BNP were measured at specific time points. Results： The levels of IL-6, TNF-a and sICAM-1 were higher after CPB in the three groups; however, the levels of IL-6, TNF-a and sICAM-1 in Group U were lower than that in Groups M and C at T2 ,T3 ,T4 and Ts time points;The levels of SOD were lower after CPB in the three groups, The levels of SOD were lower in the U and M groups than that in Groups C; The levels of MDA was higher in Group C and M and were not higher in Group U after CPB;The levels of CTn-I.CK-MB were higher after CPB in the three groups,The levels of CTn-I.CK-MB in Group U and M were higher than that in Groups C; however the levels of BNP was lower after CPB in Group U and M. Condusion： The myocardial injury in infant open heart surgery may be con- cerned with eytokine releasing and myocardial reperfusion injury. The balanced ultrafiltration combined with modified ultrafiltration degrades plasma concentrations of IL-6,TNF-α. sICAM-1 and BNP, and relieves cardial loading and improves cardial pulmonary function. However it does not relieve myocardial injury.
出处
《医学理论与实践》
2011年第16期1887-1890,共4页
The Journal of Medical Theory and Practice
关键词
超滤
体外循环
心肌损伤
心肌保护
婴幼儿
Ultrafiltration, Cardiopulmonary bypass, Myocardial injury, Myocardial protection, Infant
