摘要
目的:观察冠状动脉旁路移植术围术期肿瘤坏死因子(TNFα)的动态变化,并探讨其病理意义,以期提出更完善的治疗措施,提高手术疗效。方法:我们随机选择了32例行冠状动脉旁路移植术的病人,分别于术前、麻醉诱导期、阻断升主动脉后、后放升主动脉后、手术结束时以及术后2h、8h、24h等8个时相采集患者血样。TNFα血浆浓度应用放射免疫方法进行测定。结果:TNFα水平在阻断升主动脉后明显升高(较术前和麻醉诱导期,P<0.05),开放升主动脉后继续上升,并达到峰值,后呈下降趋势,但至术后24小时仍维持在较高活性水平(较术前,P<0.05)。开放升主动脉后心肺再灌注时TNFα浓度显著高于开放前阻断升主动脉后(P<0.05)。结论:体外循环下冠状动脉旁路移植术中的再灌注损伤触发TNFα大量释放,由于TNFα介导的炎症反应对手术预后的不良影响,拮抗其效应是心肺保护的重要策略。
Objective: We sought to observe the dynamic changes of tumor necrosis factor -α(TNFα) during periopera-tive in patients undergoing coronary artery bypass (CABG) grafting and to investigate the pathological significance so as to bring up feasible measure to increase therapeutic effect. Methods: Blood samples were drawn repectively at preopertion, anaesthesia predisposing,after aortic crossclamping and declamping, at the end of surgery and 2 hours, 8 hours, 24 hours after surgery, Plasma levels of TNFαwere measured with radioimmunoassay(RIA). Results: TNFαlevels increased immediately after aortic erossclamping and reached their peak value after reperfusion. TNFa concentration in 24 hours after surgery maintained at higher levels than that before surgery. TNFα levels after declamping were signficantly higher than that after aortic crossclamping (P < 0.05) . Conclusion:These results demonstrated that TNFα induced mainly by reperfusion injury resulted in cardiopulmonary bypass had adverse effects on myocardial recovery, Attenuation of inflammatory reactions of car-diopulmonary bypass should be considered in the strategy of myocardial protection.
出处
《中国医药导刊》
2001年第3期196-198,共3页
Chinese Journal of Medicinal Guide
关键词
肿瘤坏死因子-Α
冠状动脉旁路移植术
体外循环
围手术期
Tumor necrosis factor (TNFα)
Coronary artery bypass grafting (CABG)
Cardiopulmonary bypass (CPB)
