【摘要】 目的 评价心脏瓣膜置换术围术期血浆原降钙素（PCT）、TNF-α、IL-6、IL-8、IL-10水平的动态变化。方法　16例风湿性心脏病体外循环下行瓣膜置换术患者（体外循环组）和7例心包剥离术患者（对照组）被随机纳入本研究对象,于麻醉诱导前、气管插管后、体外循环心肺转流前、体外循环心肺转流后即刻、手术后第1天、第3天和第5天采集静脉血,采用三明治免疫发光法定量测定血浆中PCT水平,采用酶联免疫法（ELISA）定量测定血浆中TNF-α、IL-6、IL-8和IL-10水平。结果体外循环组心肺转流后即刻血浆TNF-α、IL-6、IL-8和IL-10水平明显增加（P<0.05）,术后第3天恢复;血浆PCT水平于术后第1天升高并达峰值（10.62±3.51）ng/ml,术后第5天恢复。对照组呈现同样变化趋势。但两组间参数的升高幅度有显著性差异（P<0.05）。结论 体外循环不仅促发了TNF-α、IL-6、IL-8、IL-10等促炎症和抗炎症介质的释放,而且促发了PCT的大量产生。PCT在体外循环诱发的全身炎症反应中可能发挥重要作用。更多还原

【Abstract】 ve To investigate the changes in perioperative levels of circulating procalcitonin (PCT), TNF-α, IL-6, IL-8 and IL-10 in patients undergoing valve replacement with cardiopulmonary bypass (CPB) .Methods Sixteen patients (7 male, 9 female) aged (38.5±5.1) years and weighing (42.9±10.2) kg, undergoing valve replacement under CPB were chosen in this study as CPB group and seven male patients aged (32.6±5.1) years and weighing (58.3±4.4) kg undergoing pericardectomy were enrolled in this study as non-CPB group. Patients with infection or immunodeficiency and those who had received corticosteroid and drugs which may affect immune function were excluded. Premedication consisted of intramuscular midazolam 0.1 mg/kg and morphine 0.1 mg/kg. Anesthesia was induced with midazolam 0.15mg/kg, fentanyl 8μg/kg and vecuronium 0.1mg/kg and maintained with 0.8%-1.2% isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. Blood samples were taken from CVP line before induction of anesthesia, 5 min after tracheal intubation, before CPB, immediately after discontinuation of CPB, and on 1st, 3rd, 5th, 7th postoperative day for determination of plasma PCT, TNF-α, IL-6, IL-8, and IL-10 levels. Results In CPB group plasma TNF-α, IL-6, IL-8 and IL-10 levels increased significantly immediately after CPB and returned to the baseline levels on the 3rd postoperative day, while plasma PCT concentration increased significantly after operation and reached its peak level of (10.62±3. 51) ng/ml on the 1st postoperative day. In non-CPB group there was a similar trend of changes in PCT , IL-6, IL-8 and IL-10 but to a much lesser extent.Conclusions CPB leads to a pro- and anti-inflammatory response, as well as procalcitonin release. PCT may play an important role in the systemic inflammation induced by CPB.更多还原