【作者】 刘念；

【导师】 徐军美；

【作者基本信息】 中南大学 ， 麻醉学， 2009， 硕士

【摘要】 目的:心脏手术是很强的应激反应过程,而体外循环(CPB)可诱发全身炎症反应(SIR),本课题主要探讨体外循环围术期血清E、NE与TNF-α、IL-6的关系,提示CAs对炎症的调控作用。方法:20例择期首次行心脏瓣膜置换术患者,ASA分级为Ⅱ～Ⅲ级,心功能分级(NYHA)Ⅰ～Ⅲ级,射血分数EF≥40%,无系统性疾病。具有以下情况者不列入研究对象:有活动性感染、风湿活动及血液、内分泌、免疫系统病变;近1月内应用过非甾体类药物或服用类固醇激素等免疫抑制剂药物者;人类免疫缺陷病毒HIV携带者;严重肝肾功能不全;复跳后使用肾上腺素及去甲肾上腺素等。于麻醉诱导前(T0)、CPB前(T1)、CPB停机后1h(T2)、术后4h(T3)、24h小时(T4)5个时间点采集患者桡动脉血5ml,分离血清,置于离心管内,以3000r/min离心10分钟,取上清液置于低温冰箱-20℃保存待测。采用ELISA法测定血清E、NE浓度,放免法测TNF-α、IL-6浓度。结果:CPB开始后,血清中E、NE和TNF-α、IL-6含量即开始升高,于停机后1h达到高峰,后逐渐回降,至术后24h已接近基础值。与T0比较,T2、T3两时点具有显著性差异(P＜0.01)。Spearman线性相关分析显示血清E和NE与炎性指标TNF-α、IL-6关系密切,呈明显正相关(P＜0.01)。结论:体外循环下瓣膜置换术可导致较强而短暂的炎性反应,于CPB后1h达到高峰,而CAs与促炎因子的关系密切,两者呈正相关。提示CAs可能通过调节促炎因子的释放,调控炎症反应,同时这可能是SIR的启动和发展的机制之一。更多还原

【Abstract】 Objectives:The purpose of this study was to investigate the correlations of perioperative serum catecholamines and cytokines TNF-α、IL-6 level in patients undergoing valve replacement,and it may imply that catecholamines play a critical role in controlling inflammations.Methods:Twenty patients suffered from heart disease were scheduled for elective cardiac valve replacement under CPB,who had no systemic diseases(ASA gradeⅡ～Ⅲ,NYHA gradeⅠ～Ⅲ,EF≥40%). Exclusion criteria were as follows:patients with acute infections, rheumatoid activity and blood,endocrine,immune system diseases,signs of significant liver or renal function failure,or carrying human immunodeficiency virus were not enrolled into the study.Patients treated with immune modulators(cytostatic drugs,corticosteroids) within 1 month before surgery or received epinephrine and norepinephrine after declamping of the aorta during the operation were also excluded.Blood samples were taken from radial artery at the time-points of before anesthesia(T0),before CPB(T1),1 h(T2),4 h(T3), and 24 h(T4)after the end of CPB,then the concentrations of E,NE,TNF-α,IL-6 were measured separately.Results::The serum concentrations of E,NE,TNF-α,IL-6 changed similarly during CPB,increased significantly at 1 h,4 h after the end of CPBcompared with the value before anesthesia(P＜0.01),and peaked at 1h after the end of CPB.After 24h of the end of CPB,the levels were similar to those before anesthesia(P＞0.05).Spearman correlation analysis demonstrated that there was a positive relationship between catecholamines E,NE and pro-inflammatory cytokines TNF-α,IL-6(P＜0.01).Conclusion:The cardiac valve replacement in CPB leads to a significant pro-inflammatory response and peaked at 1h after the end of CPB.Catecholamines E,NE was positively correlated with pro-inflammatory cytokines TNF-α,IL-6.It can imply that catecholamines may exert pro-inflammatory effects though regulating the release of cytokines.This might be one of possible mechanisms of systemic inflammatory response(SIR).更多还原