小儿心肺转流对术后炎性反应的影响_临床医学论文.docVIP

小儿心肺转流对术后炎性反应的影响_临床医学论文 小儿心肺转流对术后炎性反应的影响_临床医学论文 【摘要】 目的 探讨心肺转流对先天性心脏病患儿外周血细胞因子及C反应蛋白的影响。方法 实验分两组，以心肺转流组(A组)为研究对象，26例左向右分流型先天性心脏病患儿，择期行心肺转流心内直视先天性心脏病手术治疗;随机抽取同期非心肺转流胸科或腹部手术患儿30例为对照组(B组)。两组患儿分不同时间点抽取中心静脉血，采用酶联免疫分析法(ELISA)测定肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)及C反应蛋白(CRP)水平。结果 A组TNF-α、IL-6、IL-8于术后2 h、24 h分别出现两次高峰，IL-10于术后2 h出现高峰，48 h均降至正常;B组TNF-α、IL-6、IL-8、IL-10均于术后2 h达到峰值，48 h均降至正常;两组CRP均于术后24 h出现高峰，48 h仍高于正常;参数的变化幅度以A组更为显著(0.05或0.01)。结论 小儿心肺转流心内直视先天性心脏病手术可导致TNF-α、IL-6、IL-8、IL-10、CRP等促炎症和抗炎症介质的释放，在心肺转流诱发的全身炎症反应中可能发挥重要作用。 【关键词】 心肺转流;先天性心脏病;细胞因子;C反应蛋白 　　Abstract：Objective To study the impact of peripheral blood cytokines and creactive protein in children with congenital heart disease by cardiopulmonary bypass. Methods Patients were divided into two groups，and 26 cases of children with left-to-right shunt congenital heart diseases were treated by undergoing open heart surgery (group A). Randomly selected 30 cases children (group B) who were thoracic or with non-cardiopulmonary bypass symptom was chosen as the control group. TNF-α,IL-6,IL-8,IL-10,CRP were analyzed with enzyme linkedimmunoassay(ELISA) at different time points with the central venous blood. Results In group A, TNF-α,IL-6,IL-8 reached their peak levels in 2 and 24 hours and IL-10 in 2 hours after the operation, and all of them restored to the normal value in the 48 hours. In group B, All of TNF-α,IL-6,IL-8,IL-10 reached their peak levels in 2 hours and came back to the normal value in 48 hours. CRP reached the peak levels in 24 hours in both groups but continued to be higher in 48 hours. Amplitude of fluctuation in every time points was more prominent in group A.Conclusions Open-heart surgery for congenital heart diseases in children leads to a pro-and anti-inflammatory mediators release and it may play an important role in the systemic inflammatory response induced by CPB. 　　Key words：cardiopulmonary bypass;congenital heart disease;cytokine; creactive protein 　　心肺转流(cardiopulmonary bypass，C