不同滤出量平衡超滤对体外循环手术中血清炎性介质水平的影响
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摘要
目的
在体外循环(Cardiopulmonary Bypass, CPB)过程中,由于血液与体外循环管道的接触、心肌缺血-再灌注的损伤、手术创伤等因素激活了补体、中性粒细胞、血小板和血管内皮细胞,导致全身炎症反应,甚至出现全身性炎性反应综合征(Systemic inflammatory response syndrome, SIRS),临床表现为肺功能、肾功能损伤等并发症,严重者可出现多器官功能衰竭(Multiple systemic organ failure, MSOF)。
有研究表明,平衡超滤可以降低体外循环术后血清炎性介质的浓度。但目前国内外各医学中心在体外循环过程中平衡超滤量尚无统一标准,各医学中心目前应用的超滤量均为经验量,并未进行科学验证,也未见不同超滤剂量效果对比的报道。本研究对比不同滤出量平衡超滤对婴幼儿CPB术后血清炎性介质浓度的影响,以探索一较合理的平衡超滤策略。
方法
将80例先天性心脏病手术患儿随机分成对照组(C组,不进行平衡超滤),小滤出量平衡超滤组[L组,超滤量30mL/(kg·h)],中等滤出量平衡超滤组[M组,超滤量60mL/(kg·h)],大滤出量平衡超滤组[H组,超滤量90mL/(kg·h)],各组均于体外循环停机后给予改良超滤。记录临床指标,并分别于CPB开始、结束和术后2h,12h采集动脉血标本,检测肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6, IL-6)和白细胞介素-8(Interleukin-8,IL-8)指标。
结果
各组CPB时间、主动脉阻断时间无统计学差异(P>0.05),见表1。各组转流前氧合指数及术后呼吸机辅助时间无统计学差异(P>0.05),超滤组停机时及术后2、12h氧合指数高于对照组(P<0.05)
各组患儿血清中的IL-6、IL-8、TNF-α浓度在体外循环开始后均逐渐升高,在T2、T3、T4时间点都显著高于T1,但是超滤组的升高幅度明显小于对照组。在T2、T3、T4时间点超滤组IL-6、IL-8,TNF-α的浓度明显低于对照组(P<0.05),见表3。平衡超滤的三个组间比较,在T1时间点,IL-6、IL-8,TNF-α的浓度没有统计学差异,在T2,T3,T4时间点,M、H组IL-6、TNF-α浓度明显低于L组(P<0.05),在T2,T3时间点,IL-8的浓度也低于L组(P<0.05),M组和H组相比较,没有统计学差异(P>0.05)。
结论
平衡超滤清除炎性介质的作用随超滤量(Ultrafiltration Volume, UFV)的增大而增强,UFV<30mL/(kg·h)时,作用较弱,而UFV=90mL/(kg·h)时,其清除炎性介质的作用较UFV=60mL/(kg·h)时差异并不明显,因此超滤液量60mL/(kg·h)是较合理的平衡超滤策略。
Objective
In process of cardiopulmonary bypass (CPB), the contact of blood and CPB tube, myocardial ischemia and reperfusion injury, low blood pressure activate the complement, neutrophils, platelets and vascular endothelial cells, which can cause systemic inflammation, leading to systemic inflammatory response syndrome (SIRS). SIRS represents as damage of lung and kidney functiond, and even multiple organ failure (MSOF).
It is reported that balanced ultrafiltration can reduce concentration of serum inflammatory mediators after CPB. But now in various medical centers around the world, there is not a unified standard for the volume of balanced ultrafiltration during CPB. The study compared the effect of the different volume of balanced ultrafiltration on concentration of serum inflammatory mediators in infants CPB, to explore a more reasonable strategy of balanced ultrafiltration.
Methods
80 children with congenital heart disease were randomly divided into 4 groups, control group (group C), low ultrafiltrate volume(UFV) group [group L, UFV=30mL/(kg·h)], moderate UFV group [group M, UFV=60mL/(kg·h)], high UFV group [group H, UFV=90mL/(kg·h)], all of the groups were given modified ultrafiltration after termination of cardiopulmonary bypass(CPB). Serum TNF-a, IL-6, IL-8 were measured at the beginning and termination of CPB,2 hours and 12 hours postoperatively.
Results
During CPB, the concentrations of TNF-α, IL-6 and IL-8 increased significantly in group C and didn't change so significantly in trial groups. As compared among the trial groups, concentrations of TNF-a, IL-6 and IL-8 in group L were higher than group M and H (p<0.05); difference of concentrations of TNF-a, IL-6 and IL-8 between group M and H didn't reach statistical significance.
Conclusion
The study showed that function of BUF to remove inflammatory mediators increased with the UFV enhancing, when UFV<30mL//(kg-h), the effect is weak, and effect of UFV=90mL/(kg·h) didn't increase significantly as compared with UFV=60mL/(kg·h). So UFV=60mL/(kg·h) is a more reasonable BUF strategy.
Objective To evaluate the effect of different balancedd ultrafiltration(BUF) volume on inflammatory mediators in children underwent open-heart surgery. Methods 80 children with congenital heart disease were randomly divided into 4 groups, control group (groupC),low ultrafiltrate volume(UFV) group[group L, UFV=30mL/(kg·h)],moderate UFV group [group M, UFV= 60 mL/(kg·h)], high UFV group [group H, UFV=90mL/(kg·h)], all of the groups wre given modified ultrafiltration after termination of cardiopulmonary bypass(CPB). Serum TNF-a, IL-6, IL-8 were measured at the beginning and termination of CPB,2 hours and 12 hours postoperatively. Results During CPB, the concentrations of TNF-a, IL-6 and IL-8 increased significantly in group C and didn't change so significantly in trial groups. As compared among the trial groups, concentrations of TNF-a, IL-6 and IL-8 in group L were higher than group M and H (p<0.05); difference of concentrations of TNF-a, IL-6 and IL-8 between group M and H didn't reach statistical significance. Conclusion The study showed that function of BUF to remove inflammatory mediators increased with the UFV enhancing, when UFV<30mL//(kg-h), the effect is weak, and effect of UFV=90mL/(kg·h) didn't increase significantly as compared with UFV=60mL/(kg·h). So UFV 60mL/(kg·h) is a more reasonable BUF strategy.
在体外循环(Cardiopulmonary Bypass, CPB)过程中,由于血液与体外循环管道的接触、心肌缺血-再灌注的损伤、手术创伤等因素激活了补体、中性粒细胞、血小板和血管内皮细胞,导致全身炎症反应,甚至出现全身性炎性反应综合征(Systemic inflammatory response syndrome, SIRS),临床表现为肺功能、肾功能损伤等并发症,严重者可出现多器官功能衰竭(Multiple systemic organ failure, MSOF)。
有研究表明,平衡超滤可以降低体外循环术后血清炎性介质的浓度。但目前国内外各医学中心在体外循环过程中平衡超滤量尚无统一标准,各医学中心目前应用的超滤量均为经验量,并未进行科学验证,也未见不同超滤剂量效果对比的报道。本研究对比不同滤出量平衡超滤对婴幼儿CPB术后血清炎性介质浓度的影响,以探索一较合理的平衡超滤策略。
方法
将80例先天性心脏病手术患儿随机分成对照组(C组,不进行平衡超滤),小滤出量平衡超滤组[L组,超滤量30mL/(kg·h)],中等滤出量平衡超滤组[M组,超滤量60mL/(kg·h)],大滤出量平衡超滤组[H组,超滤量90mL/(kg·h)],各组均于体外循环停机后给予改良超滤。记录临床指标,并分别于CPB开始、结束和术后2h,12h采集动脉血标本,检测肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6, IL-6)和白细胞介素-8(Interleukin-8,IL-8)指标。
结果
各组CPB时间、主动脉阻断时间无统计学差异(P>0.05),见表1。各组转流前氧合指数及术后呼吸机辅助时间无统计学差异(P>0.05),超滤组停机时及术后2、12h氧合指数高于对照组(P<0.05)
各组患儿血清中的IL-6、IL-8、TNF-α浓度在体外循环开始后均逐渐升高,在T2、T3、T4时间点都显著高于T1,但是超滤组的升高幅度明显小于对照组。在T2、T3、T4时间点超滤组IL-6、IL-8,TNF-α的浓度明显低于对照组(P<0.05),见表3。平衡超滤的三个组间比较,在T1时间点,IL-6、IL-8,TNF-α的浓度没有统计学差异,在T2,T3,T4时间点,M、H组IL-6、TNF-α浓度明显低于L组(P<0.05),在T2,T3时间点,IL-8的浓度也低于L组(P<0.05),M组和H组相比较,没有统计学差异(P>0.05)。
结论
平衡超滤清除炎性介质的作用随超滤量(Ultrafiltration Volume, UFV)的增大而增强,UFV<30mL/(kg·h)时,作用较弱,而UFV=90mL/(kg·h)时,其清除炎性介质的作用较UFV=60mL/(kg·h)时差异并不明显,因此超滤液量60mL/(kg·h)是较合理的平衡超滤策略。
Objective
In process of cardiopulmonary bypass (CPB), the contact of blood and CPB tube, myocardial ischemia and reperfusion injury, low blood pressure activate the complement, neutrophils, platelets and vascular endothelial cells, which can cause systemic inflammation, leading to systemic inflammatory response syndrome (SIRS). SIRS represents as damage of lung and kidney functiond, and even multiple organ failure (MSOF).
It is reported that balanced ultrafiltration can reduce concentration of serum inflammatory mediators after CPB. But now in various medical centers around the world, there is not a unified standard for the volume of balanced ultrafiltration during CPB. The study compared the effect of the different volume of balanced ultrafiltration on concentration of serum inflammatory mediators in infants CPB, to explore a more reasonable strategy of balanced ultrafiltration.
Methods
80 children with congenital heart disease were randomly divided into 4 groups, control group (group C), low ultrafiltrate volume(UFV) group [group L, UFV=30mL/(kg·h)], moderate UFV group [group M, UFV=60mL/(kg·h)], high UFV group [group H, UFV=90mL/(kg·h)], all of the groups were given modified ultrafiltration after termination of cardiopulmonary bypass(CPB). Serum TNF-a, IL-6, IL-8 were measured at the beginning and termination of CPB,2 hours and 12 hours postoperatively.
Results
During CPB, the concentrations of TNF-α, IL-6 and IL-8 increased significantly in group C and didn't change so significantly in trial groups. As compared among the trial groups, concentrations of TNF-a, IL-6 and IL-8 in group L were higher than group M and H (p<0.05); difference of concentrations of TNF-a, IL-6 and IL-8 between group M and H didn't reach statistical significance.
Conclusion
The study showed that function of BUF to remove inflammatory mediators increased with the UFV enhancing, when UFV<30mL//(kg-h), the effect is weak, and effect of UFV=90mL/(kg·h) didn't increase significantly as compared with UFV=60mL/(kg·h). So UFV=60mL/(kg·h) is a more reasonable BUF strategy.
Objective To evaluate the effect of different balancedd ultrafiltration(BUF) volume on inflammatory mediators in children underwent open-heart surgery. Methods 80 children with congenital heart disease were randomly divided into 4 groups, control group (groupC),low ultrafiltrate volume(UFV) group[group L, UFV=30mL/(kg·h)],moderate UFV group [group M, UFV= 60 mL/(kg·h)], high UFV group [group H, UFV=90mL/(kg·h)], all of the groups wre given modified ultrafiltration after termination of cardiopulmonary bypass(CPB). Serum TNF-a, IL-6, IL-8 were measured at the beginning and termination of CPB,2 hours and 12 hours postoperatively. Results During CPB, the concentrations of TNF-a, IL-6 and IL-8 increased significantly in group C and didn't change so significantly in trial groups. As compared among the trial groups, concentrations of TNF-a, IL-6 and IL-8 in group L were higher than group M and H (p<0.05); difference of concentrations of TNF-a, IL-6 and IL-8 between group M and H didn't reach statistical significance. Conclusion The study showed that function of BUF to remove inflammatory mediators increased with the UFV enhancing, when UFV<30mL//(kg-h), the effect is weak, and effect of UFV=90mL/(kg·h) didn't increase significantly as compared with UFV=60mL/(kg·h). So UFV 60mL/(kg·h) is a more reasonable BUF strategy.
引文
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