婴幼儿心内直视手术中应用环磷酸腺苷葡胺后血浆炎性细胞因子的变化_临床医学论文.docVIP

婴幼儿心内直视手术中应用环磷酸腺苷葡胺后血浆炎性细胞因子的变化_临床医学论文 婴幼儿心内直视手术中应用环磷酸腺苷葡胺后血浆炎性细胞因子的变化_临床医学论文 作者：马辉兰，耿智隆，刘东，殷裕雄，高福兴 【摘要】 　　目的 观察婴幼儿先心病患者在心内直视手术麻醉过程中应用环磷酸腺苷葡胺后血清中TNF、IL、 IL的动态变化。方法 选择实施心内直视手术的婴幼儿先心病患者40例，随机分为M治疗组（A组）和对照组（B组）每组各20例，A组给予 M，其中1 mg/kg 于诱导前静脉注射， 1 mg/kg 稀释后输注至CPB开始，另1 mg/kg 剂量加入预充液中经转机进入体内，B组给予等量生理盐水。分别于诱导前（T0）、主动脉开放后5 min (T1)、术毕（T2）、术后12 h（T3）采桡动脉血。结果 40例婴幼儿先心病心内直视手术患者在转流前后开始CK、TNF、IL、IL均有不同程度的升高，A组与B组比较差异具有统计学意义（0.05）。结论 婴幼儿心内直视手术麻醉过程中应用环磷酸腺苷葡胺可降低CK-MB、TNF、IL的产生，提高IL的活性，改善术后心功能不全及感染。 【关键词】 TNF0 体外循环 环磷酸腺苷葡胺 麻醉 　　　Abstract： Objective To investigate the effect of meglumine cyclic adenosine monophosphate (Mrgoing cardiopulmonary bypass (CPB). Methods Forty infant patients with congenital heart disease were chosen and randomly allocated into McAMP treatment group (Group A, n=20) and control group (Group B, n=20). In Group A, McAMP was injected intraveneously before the induction of anesthesia, continuously infused before CPB, and then given during CPB (1mg/kg). The serum levels of creatine kinase (CK)MB, TNFα, IL6 and IL10 were measured respectively before induction of anesthesia, and at 5 min after aortic declamping, the end of operation and 12h after operation. Results The serum levels of CKMB, TNFα, IL6 and IL10 in the 40 patients with heart operation were increased to some extent after CPB. But compared with that of Group B, CKMB, TNFα, IL6 and IL10 of Group A differed remarkably (0.05). Conclusion McAMP not only decreases the production of CKMB, TNFα and IL6, but also improves the activity of IL10. It can thereby attenuate the heart failure and the infection after operation. 　　Key words： tumor necrosis factor; interleukin 　　婴幼儿体外循环（Cardiopulmonary bypass CPB）麻醉手术诱发的全身炎症与围术期心肌缺血及器官功能不全有关，细胞因子等炎性介质在该反应中起重要作用[1～2]。环磷酸腺苷葡胺（M）可提高心排出量、降低外周阻力[3]，但M对CPB诱发的炎性反应有无作用尚无定论。本研究拟观察40例婴幼儿心内直视手术患者CPB中应用环磷酸腺苷葡胺后血清中CK、TNF、IL、IL的动态变化，以探讨M对心肌的保护作用。 　　1 资料与方法 　　1．1 病例选择与分组 拟行心内直视手术先心病婴幼儿患者40例，ASA Ⅰ～Ⅲ级，心功能Ⅱ～Ⅲ级，年龄3～12岁，平均（7±5）岁，体重12～42 kg， 无感染及肝肾功能异常。无使用激素或免疫调节剂的病史。 随机分为