围术期容量治疗策略对心肺转流后急性炎症反应的影响.pdfVIP

? 102 ? . I临床研究· 回术期容量治疗策略对心肺转流后急性炎症 反应的影响 刘慧丽苗齐曹丽华罗爱伦黄宇先， 【摘襄】 目的 对比知乙基淀粉 130/0. 4(万汶)与就咱自先明胶(徒乐施)对心肺转流 CCPB)后急 性炎症反应的影响。方法 23 例择期 CPB 下实施冠状动脉搭桥手术 (CA日G) 的患者随机分为两组: I 组患者的 CPB 预充液及术中、术后 48 h 容量治疗选用范乙基淀粉;11 组选用玻踊酌明胶。观察网 组患者的容最治疗策略和急性炎疲反应的发生情况，并分别于麻醉诱导后、停机时、术后 2 、 24 、 48 h 采动脉血检测 C 反应蛋白 CCRP) 、自细胞介索峪6 (lL-6) 、 P 选择象( P~selectin) 和细胞问勃附即予 CICAM-1)含量。结果 两组患者的急性炎症反应发生情况相似;术后 24 、 48 h 两组 CRP 显著升高 CPO.O日，但术后 48 h 1 组比 H 组升高更为显著CPO. 05);术后 24 、 48 h 两组 ICAM-l 均较麻醉 诱导后升高 CPO.O日，而术后 48 h II 组比 I 组升高更为显著CPO.O日。*后48 h 1 组 P~Selectin 、 IL-6 ~辛苦升高 CPO.O日，组间差异无统计学态义。结论 围y长期应用经乙基淀粉有利于激活急性 期反应蛋白，并减轻内皮损伤维持内皮稳定性，从削减轻 CABG 后急性炎疲反戚。 【关键诩】 全身炎症反应综合征川、肺转流;烧乙基淀粉 ;C 反应蛋白;自细胞介家咱们 P 选择 素;细胞间教附因子 Influence of different volume replacement strategies on systemic inflammatory response syndrome after cardiopulmonary bypass LIU Hui-li , MIAO Qi , CAO Li仇ua , et al. Department of Anesthesíology , PUMC Hospítal ,Peking Union Medícal College ι:hínese Academy of Medícal Scíences , Beijing 100730 , China (Abstract Objective To compare the effect of hydroxyethylstarchCHES 130/0. 4)on systemic inflammatory response syndromp(SIRS)after cardiopulmonary bypassCCPB)with gelofusineCMFG) in patients undergoing coronary artery bypass graftìng(CABG). Methods Twenty-three patìents sched- uled for selective CABG were randomized to receive either HES 130/0.4 Cn=12.group 1) 0τMFG (group II ， n口 11)ωprime solution and volume replacement. Fluid therapy was given perioperatively and continued for 48 h after operation. 丁he incidence of SIRS was recorded. The serum concentra- tions of C-reactive proteinC CRP) ? ìnterleukìn (lL) -6. Pωselectin and intercellular adhesion molecule- l CICAM-l) w巳re measured after induction of anesthesia ,at the end of CPB ,as well as 2 h.24 h and 48 h after the end of CPB for both groups. Rωults Biometric and perioperative data of two groups were similar. There was no marked difference in the number of patients suffering from SIRS. At 24 h and 48 h after CPB ,CRP levels were