摘要
目的在体外循环模拟实验中,对平衡超滤的炎性介质滤除效果进行测定。方法建立体外循环体外模拟环路,使用健康供体人血与乳酸林格液预充体外循环管路,最终红细胞比容控制于0.24～0.28。体外循环2 h后开始平衡超滤,超滤速度控制在12 ml/min。平衡超滤时间为45 min,每隔5 min取血样5 ml和超滤液60 ml,测定样本及超滤液中炎性介质浓度:包括白细胞介素(IL)-1、IL-6、IL-10、中性粒细胞弹性蛋白酶(NE)以及肿瘤坏死因子(TNF)-α。结果超滤液中可以检测到所有类型的炎性介质,证实血液浓缩器可以滤除炎性介质。对炎性介质的动态检测发现,血液样本和超滤液中NE的浓度最高(P<0.001);血中IL-1浓度最低,而超滤液中TNF-α浓度低于其他类型的炎性介质(P<0.001)。超滤液中的炎性介质浓度与血液样本中浓度并非呈现线性关系。综合考虑超滤液中炎性介质浓度以及超滤液体积提示,血液浓缩器对于炎性介质的滤除率不超过5%。结论平衡超滤可以选择性地滤除血液中的炎性介质,综合超滤液中炎性介质浓度和体积显示,对于患者体内的炎性介质浓度及总量,平衡超滤作用有限。
Objective Ultrafiltration with hemoconcentrator may remove excess fluid load and alleviate tissue edema, and has been universally adopted in extracorporeal circulation （ECC） protocols during pediatric cardiac surgery. Balanced ultrafiltration is advocated to remove inflammatory mediators generated during surgery. However, whether balanced ultrafiltration could remove all or a portion of the inflammatory mediator load be remaining unclear. The inflammatory mediator removal capacity of zero - balanced ultraiil- tration was measured during pediatric ECC in vitro. Methods ECC consisted of cardiotomy reservoir, membrane oxygenator and arte- rial filter. H BC 20 plus was placed between arterial purge line and oxygenator venous reservoir. Fresh donor human whole blood was added into the circuit and mixed with Ringer＇s solution to obtain a final hematocrit of 0.24 - 0.28. After 2 hours of ECC, zero -balanced ultrafihration was initiated and arterial line pressure was maintained at approximately 100 mmHg with Hoffman clamp. The rate of ultrafiltration （12 ml/min） was controlled by uhrafihrate outlet pressure. Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment. Plasma and ultrafihrate samples were drawn every 5 minutes and concentrations of inflammatory mediators including interleukin - 1, interleukin -6, interleukin - 10, neutrophil elas- tase and tumor necrosis factor - a were measured. Results All assayed inflammatory mediators were detected in ultrafiltrate, demonstrafing hemoconcentration might remove inflammatory mediators. However, dynamic observations suggested the concentration of neutrophil elastase was highest among the five inflammatory mediators both in plasma and ultrafihrate （ P 〈 0.001 ）. Interleukin - 1 had the lowest concentration in plasma whereas the concentration of tumor necrosis factor - a was the lowest in ultrafihrate （ P 〈 0.001 ）. Concentrations of all inflammatory mediators in uhrafiltrate were not increased linearly compared to those in plasma. The respective ultrafiltrate to plasma concentration and amount ratios indicated hemoconcentration protocols only removed limited amounts of inflammatory mediators. Conclusion Balanced ultrafiltration might selectively remove inflammatory mediators from serum. Respective ratios of inflammatory mediators in uhrafihrate compared to plasma as well as total amount of inflammatory mediators in uhrafihrate suggest balanced uhrafihration removes a limited portion of total inflammatory mediator load.
出处
《中国体外循环杂志》
2011年第4期243-248,共6页
Chinese Journal of Extracorporeal Circulation
基金
教育部高校博士点基金(200800231118)
关键词
超滤
体外循环
炎性介质
小儿心脏外科
Uhrafiltration
Extracorporeal circulation
Inflammatory mediators
Pediatric cardiac surgery
