CAJ | 학술논문

目的探讨不同超滤策略对动脉瘤患者围术期炎性反应的影响.方法 38例主动脉弓部动脉瘤手术患者,根据体外循环(CPB)期间超滤起始时间随机分为全程超滤组和复温超滤组.在升主动脉阻断后、CPB 2 h、停CPB、停CPB 4 h抽取血标本.检测血浆及超滤液中白细胞介素(IL)-1、IL-6、IL-10、中性粒细胞弹性蛋白酶(NE)及肿瘤坏死因子(TNF)-α浓度.结果血浆IL-1和TNF-α在整个手术过程变化不显著(P＞0.05).IL-6、IL-10及NE在停CPB时显著升高(P＜0.05).CPB 4 h后IL-10血浆浓度(148.57±83.28) ng/L较停CPB时(319.03±67.51) ng/L显著下降(P＜0.05),而IL-6及NE未见显著下降(P＞0.05).各时点间各种炎性因子血浆浓度在两组间差异无统计学意义(P＞0.05).结论全程持续性超滤对血浆炎性因子变化的影响未见优于复温后超滤.
목적 탐토불동초려책략대동맥류환자위술기염성반응적영향.방법 38례주동맥궁부동맥류수술환자,근거체외순배(CPB)기간초려기시시간수궤분위전정초려조화복온초려조.재승주동맥조단후、CPB 2 h、정CPB、정CPB 4 h추취혈표본.검측혈장급초려액중백세포개소(IL)-1、IL-6、IL-10、중성립세포탄성단백매(NE)급종류배사인자(TNF)-α농도.결과 혈장IL-1화TNF-α재정개수술과정변화불현저(P＞0.05).IL-6、IL-10급NE재정CPB시현저승고(P＜0.05).CPB 4 h후IL-10혈장농도(148.57±83.28) ng/L교정CPB시(319.03±67.51) ng/L현저하강(P＜0.05),이IL-6급NE미견현저하강(P＞0.05).각시점간각충염성인자혈장농도재량조간차이무통계학의의(P＞0.05).결론 전정지속성초려대혈장염성인자변화적영향미견우우복온후초려.
Objective To investigate the effect of high-volume ultrafiltration on inflammatory factors in aortic arch replacement surgery under deep hypothermic circulatory arrest (DHCA).Methods 38 patients who need aortic arch replacement surgery with DHCA were enrolled in the study,and were assigned to receive continuous ultrafiltration which started at the initiation of CPB or ultrafiltration started at rewarming(control group).Blood samples were collected 10 min following crossclamp (T1),2 h of CPB (T2),at end of CPB (T3) and 4 h following CPB (T4).All ultrafiltrate was collected at the end of ultrafiltration.The inflammatory reaction degree was assessed with measurement of interleukin-1 (IL-1),IL-6,IL-10,neutrophil elastase(NE) and tumor necrosis factor-α (TNF-α).Results The plasma concentrations of IL-1 and TNF-α were not significantly changed during the whole process (P ＞ 0.05).At end of CPB,the concentrations of IL-6、IL-10 and NE increased significantly compared to the concentrations of T1 (P ＜ 0.05).4h after CPB,the concentrations of IL-10 decreased significantly (T3,319.03 ± 67.51 ng/L;T4 148.57 ± 83.28 ng/L),while the concentrations of IL-6 and NE were still at high level(P ＞0.05).Repeated measures analyses of variance(ANOVA) showed there was no difference of all these five inflammatory factors in plasma between the two groups at every time points(P ＞ 0.05).At the end of CPB,plasma hemoglobin and glucose were significantly superior in continuous ultra.filtration group.Conclusion The inflammatory factor elimination effect of continuous ultrafiltration is not superior to ultraflltration after rewarming.