摘要
目的 观察进行体外循环 (CPB)病人围术期动脉血和冠脉血肿瘤坏死因子 (TNF α)、超氧化物歧化酶 (SOD)、脂质过氧化物 (LPO)及肌酸激酶 MB(CK MB)的变化。方法 13例病人分别于CPB前、升主动脉开放后 5min、30min、术毕、术后 6h、术后 18h采集动脉和冠状窦血样本 ,测定血浆TNFα、LPO的浓度及SOD、CK MB的活性和动脉血气 ,测算不同时间点的肺泡动脉氧分压差 (PA aDO2 ) ,心肌TNF α的净释出量 (冠状窦内血液TNFα含量减去动脉血含量 )。结果 血液的TNFα水平在开放升主动脉后至术毕前明显增高 (P <0 0 5 ) ,CPB期间心肌TNFα净释出量明显增高 (P <0 0 5 ) ;LPO在开放升主动脉后明显升高且持续到术后 6h(P <0 0 5 ) ,其峰值在开放升主动脉后 5min ;SOD含量逐渐下降并在术毕时降至最低值 (P <0 0 5 )。围术期心肌CK MB释出量明显增加 (P <0 0 1) ,而且与升主动脉阻断时间明显正相关 (r=0 749,P <0 0 1)。PA aDO2 转流后明显增加 (P <0 0 5 ) ,术后 6h恢复正常。结论 人类心肌在CPB期间具有分泌炎性细胞因子 (TNF α)的作用 ;CPB会引起全身及心脏的炎性反应以及氧自由基损伤 ,并由此加重心脏瓣膜外科病人已经存在的心功能及肺功能损害且使术后恢复延迟。
Objective To determine perioperative changes of tumor necrosis factor alpha (TNF α),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF α and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF α (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNFα levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P<0 05), the net myocardial release of TNF α increased significantly during CPB (P<0 05) Arterial and coronary sinus LPO levels rose markedly following aortic declamping and the high level persisted until 6 h after surgery (P<0 05) Arterial and coronary sinus SOD activities decreased gradually and reached the lowest level at the end of operation (P<0 05) Myocardial CK MB release increased significantly and was positively correlated with the duration of aortic cross clamping(r=0 749, P<0 01) P A a DO 2 after CPB was elevated significantly and returned to normal value 6 h after surgery Conclusions Humans myocardium can secrete the inflammatory cytokine (TNF α) during CPB CPB can also induce systemic and myocardial inflammatory responses and release oxygen free radicals, aggravating the preexisting decreased cardiac and pulmonary function in patients with heart valves disease and prolong the postoperative recovery duration
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2000年第12期717-720,共4页
Chinese Journal of Anesthesiology
关键词
心脏瓣膜置换术
围手术期
动脉血
冠脉血
TNF-Α
Heart valve diseases
Cardiopulmonary bypass
Tumor necrosis factor alpha
Superoxide dismutase
Lipid peroxides
Creatine kinase isoenzymes
