【摘要】 目的评估体外循环(CPB)中动脉路白细胞(WBC)滤除对心脏手术后患者肺功能的影响。方法择期CPB下行心脏瓣膜置换术患者40例,其中男21例,女19例,年龄22～65岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=20):对照组和试验组。对照组不使用WBC滤器,试验组在泵后动脉滤器前串连一个WBC滤器,复温前开放WBC滤器旁路,复温开始后关闭旁路并开始滤过外周血中的WBC,直到CPB结束。分别采集患者CPB转机前(T1),主动脉开放后10 min(T2),CPB结束时(T3),CPB结束后12 h(T4)、24 h(T5)体内动脉血各5 ml,检测血液中WBC、中性粒细胞(NEU)计数和血清中肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、血清丙二醛(MDA)和过氧化物歧化酶(SOD)含量;同时记录各时点呼吸参数、动脉血气,计算肺静态顺应性(Cstat)、氧合指数(OI)、呼吸指数(RI);比较两组术后机械通气时间、ICU停留时间、氧饱和度下降率、肺感染发生率和住院时间。结果与对照组比较,试验组在T3～T5时血中WBC及NEU计数明显减低(P <0.05);试验组在T2～T5时血清TNF-α、IL-6、MDA浓度和RI均降低,血清SOD浓度增高(P <0.05);试验组在T3～T5时Cstat、OI增高(P <0.05);试验组在术后机械通气时间、ICU停留时间缩短,术后氧饱和度下降率均降低(P <0.05)。结论 CPB中动脉路WBC滤除可通过减少血液中活化的WBC,减轻全身炎症反应,改善患者肺功能。更多还原

【Abstract】 Objective To evaluate the effects of leukocyte depletion in the arterial line during cardiopulmonary bypass on postoperative pulmonary function in patients after cardiac surgery. Methods Forty patients aged 22-65 yr,with American Society of Anesthesiologists Physical Status Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement surgery with CPB,were divided into two groups( n = 20 each) by using a random number table. In experimental group( group LD),blood was filtered with a leukocyte depleting filter placed in the arterial line of the CPB circuit since the start of rewarming until the termination of CPB. Blood samples were taken before CPB( T1),ten minutes after aortic unclamping( T2),at the end of CPB( T3),12 and 24 h after T3( T4-5) to examine blood components and serum levels of TNF-α,IL-6,MDA and SOD. Meanwhile respiratory ventilation parameters and blood gas analyses were also recorded to calculate the static pulmonary compliance( Cstat),oxygenation index( OI) and respiratory index( RI). The mechanical ventilation time,ICU stay time,incidence of oxygen desaturation and pulmonary infection were compared between the two groups after surgery. Results Compared with control group( group C),WBC and NEU counts significantly decreased at T3-5 in group LD( P <0.05). The serum concentrations of TNF-α,IL-6,MDA and RI significantly decreased at T2-5,while the SOD concentrations increased at T2-5( P <0.05). Cstat and OI increased at T3-5 in group LD( P <0.05),while the the mechanical ventilation time,ICU stay time significantly decreased in group LD( P <0.05). Conclusion An arterial line leukocyte depletion during cardiopulmonary bypass can inhibit inflammatory responses and improve the postoperative pulmonary function after cardiopulmonary bypass.更多还原