CAJ | 학술논문

目的研究小儿体外循环(cardiopulmonary bypass,CPB)中不同氧合器对中性粒细胞(PMN)凋亡的影响,为减轻体外循环伞身炎症反应提供新的思路.方法将60例室间隔缺损患儿随机分为两组(n=30):西京-90鼓泡式氧合器组(B组)和希健-Ⅱ膜式氧合器组(M组).分别于CPB前、CPB结束时、CPB结束后4、8、24 h 5个时点采取静脉血,以伞血细胞计数仪测定PMN数量,流式细胞仪测定PMN凋亡率和PMN表面黏附分子CD11b表达变化,ELISA法测定血浆弹性蛋白酶浓度.结果两组患者CPB结束后PMN凋亡率明显降低(P<0.05),PMN数量、CD11b表达、血浆弹性蛋白酶浓度明显升高(P<0.05),在CPB结束时及CPB结束后4、8 h PMN凋亡率M组均高于B组(P<0.05);而PMN数量、CD11b表达、血浆弹性蛋白酶水平B组均高于M组(P<0.05).CPB结束后24 h PMN数量B组高于M组(P<0.05).结论与西京-90鼓泡氧合器相比,应用希健-Ⅱ膜式氧合器可以减轻CPB对PMN凋亡的抑制,进而减轻全身炎症反应.
목적 연구소인체외순배(cardiopulmonary bypass,CPB)중불동양합기대중성립세포(PMN)조망적영향,위감경체외순배산신염증반응제공신적사로.방법 장60례실간격결손환인수궤분위량조(n=30):서경-90고포식양합기조(B조)화희건-Ⅱ막식양합기조(M조).분별우CPB전、CPB결속시、CPB결속후4、8、24 h 5개시점채취정맥혈,이산혈세포계수의측정PMN수량,류식세포의측정PMN조망솔화PMN표면점부분자CD11b표체변화,ELISA법측정혈장탄성단백매농도.결과 량조환자CPB결속후PMN조망솔명현강저(P<0.05),PMN수량、CD11b표체、혈장탄성단백매농도명현승고(P<0.05),재CPB결속시급CPB결속후4、8 h PMN조망솔M조균고우B조(P<0.05);이PMN수량、CD11b표체、혈장탄성단백매수평B조균고우M조(P<0.05).CPB결속후24 h PMN수량B조고우M조(P<0.05).결론 여서경-90고포양합기상비,응용희건-Ⅱ막식양합기가이감경CPB대PMN조망적억제,진이감경전신염증반응.
Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.