【摘要】 目的　评价心内直视手术期间使用滤除白细胞的血液灌注液对心肌的保护效果。方法　 30例择期行心脏瓣膜替换术的患者 ,ASAⅡ～Ⅳ级 ,均采用芬太尼 安氟醚复合麻醉 ,以 4℃高钾晶体液灌注停跳 ,据第二次灌注液成份不同随机分为 3组 ,每组 10例 :晶体液组 (CS)、全血组 (WB)和去白细胞血 (LD)组。于肝素化前 ,CPB开始 5min ,主动脉开放前 5min ,开放后 30min、1h、2h、2 4h采取外周动脉血测定CK MB、IL 8、TNFα浓度 ;于主动脉阻断前、开放前、开放后 15min取右心房心肌标本 ,测定心肌含水量和心肌组织Ca2 + 含量 ,观察心肌组织超微结构改变 ,对心肌线粒体变化进行半定量评价。结果　开放主动脉后 ,每组CK MB、IL 8水平较开放前明显升高 ,开放后 2h升高更明显 (P <0 0 5 ) ,但LD组明显低于CS组和WB组 (P <0 0 5 )。TNFα水平未发生明显变化。与CS组和WB组相比 ,LD组的心肌组织Ca2 + 含量 ,线粒体半定量评价分级 ,脱机前多巴胺用量均明显降低 (P <0 0 5 ) ,而开放主动脉后心脏自动复跳率明显升高 (P <0 0 5 )。心肌含水量各组间无明显差异 (P >0 0 5 )。电镜下可见肌原纤维排列较整齐 ,线粒体肿胀不明显 ,嵴结构较完整。结论　去除白细胞的血液灌注液可有效地减轻心内直视手术中病人心肌缺血再灌注损?更多还原

【Abstract】 Objective In addition to myocardial ischemia,massive inflammatory mediators and different enzymes are released and free radicals increase during cardiopulmonary bypass(CPB) due to the contact of blood with foregin material Leukocytes play an important role The purpose of this study was to evaluate the myocardial protective effect of leukocyte depleted blood perfusion during open heart surgery Methods Thirty adult ASA II IV patients scheduled for elective orthotopic valve replacement received fentanyl enflurane anesthesia A bolus of 3 mg/kg intravenous heparin was given before CPB Cardiac arrest was induced with 4 ℃ hyperkalemic crystalliod cardioplegic solution Patients were randomly allocated to one of 3 groups based on the types of cardioplegic solution used during CPB: crystalloid solution(group CS, n=10),whole blood (group WB,n=10), and leukocyte depleted blood (group LD,n=10) Blood samples were taken from peripheral artery before heparinization, 5 min after initiation of CPB ,5 min before and 30 min, 1 h, 2 h and 24 h after declamping of aorta respectively for determinations of creatine kinase MB(CK MB), interleukin 8(IL 8) and tumor necrosis factor alpha(TNFα) Myocardial tissuses were obtained from right atrium before cross clamping of aorta, before and 15 min after declamping of aorta for determinations of water content,Ca 2+ content and ultrastructure examination of myocardium Results After declamping plasma concentrations of CK MB and IL 8 significantly increased in all groups as compared to the values before declamping (P<0 05), but the values in group LD were markedly lower than those in group CS and group WB (P<0 05 or 0 01) The TNFα remained unchanged during the whole process in all groups Myocardial Ca 2+ content was significantly lower in group LD than that in group CS and WB (P<0 05 or 0 01) Semiquantitative assessment of myocardial mitochondria showed that the status level was obviously lower in group LD 15 min after declamping than that in other groups(P<0 05) The ultrastructure observation examination showed that the myofilaments appeared normal and the mitochondia had normal cristae and matrix The incidence of restoring spontaneous heart beat after declamping was markedly higher in group LD (80%) than that in group CS (50%) and group WB (40%)(P<0 05) The amount of dopamine used was significantly lower in group LD compared with that of other groups (P<0 05) Conclusions The LD blood perfusion can effectively reduce the myocardial ischemia reperfusion injury in the patients undergoing open heart surgery更多还原