【摘要】 目的观察体外循环（CPB）中使用6%羟乙基淀粉130/0.4对心脏瓣膜置换术病人外周血中性粒细胞（PMN）核因子κB（NF-κB）的影响。方法心脏二尖瓣瓣膜置换术病人60例,ASAⅡ或Ⅲ级,随机分为2组,每组30例,试验组和对照组人工心肺机中分别预充6%羟乙基淀粉130/0.4和琥珀酰明胶15 mL·kg^-1,并分别于气管插管后至CPB开始前静脉输注6%羟乙基淀粉130/0.4和琥珀酰明胶10 mL·kg^-1。观察术中血流动力学变化、主动脉阻断时间、CPB时间及手术时间等,在麻醉诱导插管后即刻（T₀）、升主动脉开放即刻（T₁）、CPB停机即刻（T₂）和手术结束时（T₃）分别抽取外周动脉血,分离PMN,检测NF-κB总量、活化NF-κB p65及磷酸化NF-κB p65的含量。结果2组主动脉阻断时间、CPB时间及手术时间均无显著差异,术中4个时点平均动脉压、中心静脉压、心率、血细胞比容、PMN数量及NF-κB总量组间差异亦无显著意义（P>0.05）。与对照组相比,试验组T₀时PMN中活化NF-κB p65、磷酸化NF-κBp65的含量无显著差异（P>0.05）;T₁、T₂、T₃时2组活化及磷酸化NF-κB p65均升高（P<0.05）,试验组升高幅度低于对照组,差异显著（P<0.05）。结论CPB中应用6%羟乙基淀粉130/0.4可抑制外周血PMN的NF-κB活性,可能为其减轻CPB触发的炎性反应机制之一。更多还原

【Abstract】 AIM To investigate the effects of 6%hydroxyethyl starch 130/0.4 on the nuclear factor kappa B（NF-κB） activity of neutrophils in patients undergoing cardiac valve replacement with cardiopulmonary bypass（CPB）.METHODS Sixty ASAⅡorⅢpatients undergoing cardiac mitral valve replacement with CPB were randomized into 2 groups（n = 30 each）.Heart-lung machine were processed with 6%hydroxyethyl starch 130/0.4（groupⅤ） and succinylated gelatin（group C） 15 mL·kg^-1,respectively.The 6%hydroxyethyl starch 130/0.4 or succinylated gelatin 10 mL·kg^-1 was intravenously infused between the time after intubation and before CPB.Intraoperative hemodynamic changes,aortic cross-clamping time,the CPB turn around time and operation time were recorded.Neutrophiles were isolated from peripheral blood,which were collected from peripheral artery after induction of anesthesia（T₀）,opening aortic cross-clamping in CPB（T₁）,at the end of CPB（T₂） and at the end of operation（T₃）.neutrophil cytoplasmic protein were extracted and quantitated,and the content of activation of NF-κB p65,acidification of NF-κB p65 and total NF-κB were tested.RESULTS There were no significant differences in aortic cross-clamping time,CPB time,operation time and mean arterial pressure,heart rate,central venous pressure,hematocrit,neutrophil number and total amount of NF-κB at four time point between two groups.There were no significant difference in the content of activation of NF-κB p65 and acidification of NF-κB p65 of neutrophils at T₀（P>0.05） between two groups.Compared with group C,the content of activation of NF-κB p65 and acidification of NF-κB p65 were significantly lower at T₁,T₂ and T₃ in groupⅤ（P<0.05）.CONCLUSION The application of 6%hydroxyethyl starch 130/0.4 in CPB could inhibit the expression of NF-κB in peripheral blood neutrophils,thereby reducing the inflammatory response triggered by CPB.更多还原