【摘要】 目的 探讨心肺转流下法洛四联症根治术患儿静脉注射米力农后围术期血浆C-反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)浓度的变化。方法择期行法洛四联症根治术患儿16例,ASAⅢ-Ⅳ级,随机分为2组,每组8例,米力农组(M组)和对照组(C组)。M组在主动脉开放后立即静脉输入米力农负荷量50 μg·kg-1,10 min内输完,继之以静脉输注维持量0.2 μg·kg-1·min-1;C组以同样方法输注等量乳酸钠林格液。抽取患儿中心静脉血,采用放射免疫法定量测定血浆CRP、TNF-α、IL-8及IL-10的浓度。结果 与麻醉前比较,两组血浆CRP浓度术后24、48 h均升高(P<0.01);与M组比较,C组血浆CRP浓度停机后5 min、术毕时升高,术后24、48 h降低(P<0.05)。TNF-α血浆浓度组内各时间点、组间比较差异无显著性(P>0.05)。与麻醉前比较,M组血浆IL-8浓度在停机后5 min和术毕时均升高(P<0.05),C组血浆IL-8浓度在各时点均升高(P<0.05);与M组比较,C组血浆IL-8浓度在主动脉开放后5 min、术毕、术后24 h升高(P<0.05)。与麻醉前比较,M组血浆IL-10浓度在停机后5 min、术毕、术后24、48 h升高(P<0.05),C组各时点差异均无显著性(P>0.05);与M组比较,C组血浆IL-10浓度在停机后5 min、术毕、术后24、48 h降低(P<0.05)。结?更多还原

【Abstract】 Objective To evaluate the effects of milrinone on plasma levels of C reactive protein (CRP) , TNF-α, IL-8 and IL-10 during and after operation for tetralogy of Fallot performed under cardiopulmonary bypass (CPU) in children.Methods Sixteen ASA Ⅲ-Ⅳ pediatric patients aged l-12yr scheduled for operation for tetralogy of Fallot under CPB were randomly divided into two groups : (1) milrinone group ( M, n = 8) and (2) control group (C, n = 8) . In group M a loading dose of milrinone 50 μg·kg-1 was given i.v. within 10 min, immediately after aortic unclamping, followed by continuous infusion at 0.2μg·kg ?min-1 . In group C equal volume of lactated Ringer’s solution was infused instead of milrinone. Blood samples were taken from the CVP line before anesthesia (T0), 5 min after release of aortic cross-clamp (T1), 5 min after discontinuation of CPB (T2) , at the end of surgery (T3) and 24 h and 48h after operation (T4,5) for determination of plasma levels of CRP, TNF-α, IL-8 and IL-10 by radioimmunoassay.Results There was no significant change in plasma TNF-a concentration in both groups. Plasma CRP level increased significantly at 24 and 48 h after operation (T4 , T5 ) , in both groups and was significantly higher in group M than that in group C. Plasma IL-8 level increased significantly only at T2 and T3 compared to pre-anesthesia value (T0) in group M while in group C it increased significantly from T1-5 (P < 0.05) , and was significant higher at T1,3,4 in group C than that in group M (P < 0.05). Plasma IL-10 level increased significantly after termination of CPB ( T2-5) compared with the baseline value in both groups and was significantly higher in group M than that in group C ( P < 0.05). Conclusion Milrinone inhibits the systemic inflammatory response to surgery and CPB in children.更多还原