【摘要】 目的本研究通过观察小婴儿体外循环(extracorporeal circulation,ECC)手术围术期炎性指标的变化及临床效果来评价聚-2-膦酰甲氧乙基腺嘌呤(poly-2-methoxyethylacrylate,PMEA)涂层管道的生物相容性,为临床应用提供依据。方法将20例在ECC下进行大型室间隔缺损合并肺动脉高压手术的患儿随机分为PMEA涂层管道组(A组)和非涂层组(B组),每组10例。两组患儿一般资料相仿。所有患儿均在麻醉成功开胸前(T1)、ECC 30min(T2)、ECC结束鱼精蛋白中和后(T3)、术后4 h(T4)和术后24 h(T5)5个时间点采取动脉血,测定血常规、C反应蛋白(CRP)、白介素(IL)1β、IL-6、IL-8、IL-10、肿瘤坏死因子(TNF-α)。术前、术后24 h常规测定肝肾功能、白、球蛋白及电泳、心肌肌钙蛋白I(cTnI)值,并进行术后机械通气时间、术后24 h尿量、心包引流量、血制品用量、ICU滞留时间及术后肺功能比较。结果血小板计数(T3、T4)A组明显高于B组(P<0.05)。各时间点白细胞计数、IL-10、TNF-α无明显差异。IL-6(T4、T5)、CRP(T5)、IL-1β(T5)、IL-8(T5)A组升高低于B组(P<0.05)。术后肝肾功能两组相仿;而cTnI A组升高低于B组(P<0.05)。术后机械通气气道峰压A组低于B组,术后肺功能好于B组。术后尿量、机械通气时间、ICU滞留时间相仿。A组心包引流量及血制品用量少于B组(P<0.05)。结论PMEA涂层体外循环管道具有良好的生物相容性,具有减轻ECC诱发的全身炎性反应和保护血小板的作用,临床上体现出保护肺功能的良好结果。更多还原

【Abstract】 OBJECTIVE To evaluate the effect of PMEA(Poly-2-methoxyethylacrylate)coated circuits in infants on inflammatory response during the extracorporeal circulation(ECC) by examining the inflammation cytokines and clinical performance,and provide basis for clinical application.METHODS 20 infants undergoing VSD repair were divided into two equal groups.Group A had operation with PMEA coated oxygenators and circuits and group B had operation with all noncoated circuits.Blood test results,C-reactive protein,interleukin(IL) 1β,IL-6,IL-8,IL-10,TNF-α were documented preoperatively(T1),on ECC(30 minutes)(T2),after protamine sulfate reversal(T3),4 hours after surgery(T4) and on the first post-operative day(T5).The renal,liver and cardiac function,the albumin and globin,protein electrophoresis were performed pre-and post-operatively.The respiratory function, drainage quantity,blood product utilization and ICU stay time were recorded.RESULTS The platelet count in group A was significantly higher than group in B in T3 and T4(P<0.05).The PMEA group had less IL-6 in T4 and T5,less CRP,IL-1β,IL-8 in T5 compared with noncoated group(P<0.05).No significant differences in IL-10 and TNF-α between 2 groups.The cTnI was less in PMEA group post-operatively compared with noncoated group.The clinical results analysis demonstrated pulmonary function in group A is better than group B and post-operative drainage quantity and blood product utilization is less in group A.CONCLUSION The PMEA circuits had better biocompatibility and can significantly reduce cytokines induced by ECC and consumption of platelet.It also demonstrated wonderful clinical results and protect the pulmonary function.We now routinely use PMEA-coated oxygenator and arterial filter in open heart surgeries in neonates and infants.更多还原