中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2008年
22期
21-23
,共3页
体外循环%脑损伤%炎症反应
體外循環%腦損傷%炎癥反應
체외순배%뇌손상%염증반응
Cardiopulmonary bypass%Cerebral injury%Inflammatory response
目的 探讨体外循环心脏手术中脑损伤的可能机制及其与炎症反应的关系.方法 24例在体外循环下(CPB)下行室间隔缺损(VSD)修补术的患儿,随机分为乌司他丁组(UTI组)和对照组.分别于手术前(T1)、复温至36℃(T2)、CPB后30 min(T3)、CPB后4h(T<,4>)抽取颈静脉血,用ELISA法测定S100β蛋白、神经元特异性烯醇化酶(NSE)及白细胞介素10(IL-10)浓度,用放射免疫法测定肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)浓度.结果 CPB前两组患儿血浆S100β蛋白和NSE浓度以及血浆细胞因子TNF-α、IL-6、IL-8及IL-10浓度比较差异均无统计学意义(P>0.05).CPB后各时点,UTI组患儿血浆S100β蛋白、NSE、TNF-α、IL-6及IL-8浓度明显低于对照组,而UTI组患儿血浆IL-10浓度明显高于对照组,差异均有统计学意义(P<0.05).结论 CPB下心内直视术对脑有一定的损伤,其作用机制可能是与CPB期促炎细胞因子的释放、上调抗炎细胞因子有关.
目的 探討體外循環心髒手術中腦損傷的可能機製及其與炎癥反應的關繫.方法 24例在體外循環下(CPB)下行室間隔缺損(VSD)脩補術的患兒,隨機分為烏司他丁組(UTI組)和對照組.分彆于手術前(T1)、複溫至36℃(T2)、CPB後30 min(T3)、CPB後4h(T<,4>)抽取頸靜脈血,用ELISA法測定S100β蛋白、神經元特異性烯醇化酶(NSE)及白細胞介素10(IL-10)濃度,用放射免疫法測定腫瘤壞死因子-α(TNF-α)、白細胞介素6(IL-6)、白細胞介素8(IL-8)濃度.結果 CPB前兩組患兒血漿S100β蛋白和NSE濃度以及血漿細胞因子TNF-α、IL-6、IL-8及IL-10濃度比較差異均無統計學意義(P>0.05).CPB後各時點,UTI組患兒血漿S100β蛋白、NSE、TNF-α、IL-6及IL-8濃度明顯低于對照組,而UTI組患兒血漿IL-10濃度明顯高于對照組,差異均有統計學意義(P<0.05).結論 CPB下心內直視術對腦有一定的損傷,其作用機製可能是與CPB期促炎細胞因子的釋放、上調抗炎細胞因子有關.
목적 탐토체외순배심장수술중뇌손상적가능궤제급기여염증반응적관계.방법 24례재체외순배하(CPB)하행실간격결손(VSD)수보술적환인,수궤분위오사타정조(UTI조)화대조조.분별우수술전(T1)、복온지36℃(T2)、CPB후30 min(T3)、CPB후4h(T<,4>)추취경정맥혈,용ELISA법측정S100β단백、신경원특이성희순화매(NSE)급백세포개소10(IL-10)농도,용방사면역법측정종류배사인자-α(TNF-α)、백세포개소6(IL-6)、백세포개소8(IL-8)농도.결과 CPB전량조환인혈장S100β단백화NSE농도이급혈장세포인자TNF-α、IL-6、IL-8급IL-10농도비교차이균무통계학의의(P>0.05).CPB후각시점,UTI조환인혈장S100β단백、NSE、TNF-α、IL-6급IL-8농도명현저우대조조,이UTI조환인혈장IL-10농도명현고우대조조,차이균유통계학의의(P<0.05).결론 CPB하심내직시술대뇌유일정적손상,기작용궤제가능시여CPB기촉염세포인자적석방、상조항염세포인자유관.
Objective To investigate the possible mechanisms involvedin cerebral injuryin heart operation during and after cardiopulmonary bypass(CPB), and the relation between cerebral injury and the inflammatory response. Methods Twenty-four patients undergoing heart remedy operation for ventricular septal defect(VSD) with CPB in cardiac surgery department of the Center Hospital of Zhumadian were studied. All patients were randomly divided into ulinastatin (UTI) group (n=12) and control group (n=12). Blood samples were taken from artery at four times intervals : after induction of anesthesia (T1), when rewarming to 36℃(T2), 30 min (T3) and 4h(T<,4>) after discontinuation of CPB for determination of plasma S100β protein, neuronspeeifi-cevolase (NSE), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10(IL-10). Results The plasma concentrations of S100β protein, NSE, TNF-α, IL-6 IL-8 and IL-10 were no signifi-cant differences between the two groups before CPB(P > 0.05). During and after CPB the plasma level of S100β protein,NSE, TNF-α, IL-6 and IL-8 were lower in group UTI than that in group control (P < 0.05), and the value of IL-10was higher in group UTI than that in group control (P < 0.05). Conclusion Heart operation under cardiopulmonary by-pass can result cerebral injury. The possible mechanism is related to proinflammatory cytokines and at the same time in-crease in anti-inflammatory cytokines.
