羟乙基淀粉对体外循环后急性炎性反应影响.docVIP

羟乙基淀粉对体外循环后急性炎性反应影响 　 作者：刘慧丽，苗齐，曹丽华，罗爱伦，黄宇光 【摘要】 目的 观察羟乙基淀粉130/0.4（万汶）用于体外循环(extracorporeal circulation,ECC)冠脉搭桥手术的安全性，及其对ECC后急性炎性反应的影响。方法 24例患者随机分为两组，组Ⅰ的ECC预充液及围术期48h容量治疗选用万汶；组Ⅱ使用琥珀酰明胶(佳乐施)。观察两组患者的容量治疗策略和急性炎性反应的发生情况、肝肾和凝血功能指标的变化，并采取动脉血检测C反应蛋白(CRP)、白介素-6(IL-6)、P选择素(P-selection)和细胞间黏附因子(ICAM－1)的含量。结果 组Ⅰ患者的天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）较组Ⅱ患者显著升高（Plt; 0.05）。两组患者的急性炎性反应的发生情况相似；与组Ⅱ相比，组Ⅰ患者术后48 h的CRP升高更为显著（Plt; 0.05）；术后48 h，组Ⅱ患者的ICAM－1升高更为显著（Plt; 0.05）。结论 羟乙基淀粉130/0.4可用于冠状动脉旁路移植术（CABG）患者围术期容量治疗，但应警惕其对患者肝功能的潜在影响，另外，羟乙基淀粉130/0.4有利于激活急性期反应蛋白，维持内皮稳定，从而减轻CABG后急性炎性反应。 【关键词】 急性炎性反应综合征；体外循环；容量治疗；C反应蛋白；白介素-6；P选择素；细胞间黏附因子 　　Effect of Hydroxyethyl Starch on Systemic Inflammatory Response Syndrome after Extracorporeal Circulation 　　Abstract: OBJECTIVE To investigate the safety of hydroxyethyl starch (HES) 130/0.4 in patients undergoing coronary artery bypass grafting (CABG), and to compare its efficacy on systemic inflammatory response syndrome（SIRS） after extracorporeal circulation (ECC) with Gelofusine. METHODS Twenty-four patients scheduled for elective CABG were randomized to receive either HES 130/0.4 (group Ⅰ,n=12) or Gelofusine (group Ⅱ,n=11) as prime solution and volume replacement. Fluid therapy was given perioperatively and continued for 48 h postoperation. The incidence of SIRS,postoperative clinical parameters and blood biochemistry were recorded. The serum concentrations of C-reactive protein (CRP), interleukin (IL)-6, P-selection and intercellular adhesion molecule-1 (ICAM-1) were measured after induction of anesthesia,at the end of ECC,as well as 2 hours, 24 hours and 48 hours after the end of ECC for both groups. RESULTS Liver enzymes in group Ⅰ were significantly higher than that in group Ⅱ(Plt;0.05). There was no difference in the number of patients suffering from SIRS. Twenty-four and 48h after ECC, the CRP levels were increased in two groups, but the difference was statistically significant only at 48h between the two groups (Plt;0.05). Serum concentrations of ICAM-1 w