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.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 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：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 1 1 资料与方法 3 2 结果 4 3 讨论 5 文2：婴幼儿心内直视手术中改良超滤技术的运用 6 1 资料和方法 6 2 结果 8 3 讨论 8 参考文摘引言： 10 原创性声明（模板） 11 文章致谢（模板） 12 正文 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 文1：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 Abstract： Objective To investigate the effect of meglumine cyclic adenosine monophosphate (McAMP) on the serum levels of interleukin (IL)6, IL10 and tumor necrosis factor (TNF)α in infant patients with congenital heart disease undergoing 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 (P). 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6; interleukin10; cardiopulmonary bypass; meglumine cyclic adenosine monophosphate; anesthesia 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cAMP）可提高心排出量、降低外周阻力[3]，但McAMP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MB、TNFα、IL6、IL10的动态变化，以探讨McAMP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