【摘要】 目的探讨在体外循环(cardiopul monary bypass,CPB)下心脏手术围术期动态检测血清心肌肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)、细胞因子(CK)和补体C3、C4水平的临床意义。方法选择20例行CPB和10例非CPB心脏手术患者,分别于术前、术后即刻、24h、48h和72h测定其血清cTnT、hs-CRP、促炎CK(TNF-α、IL-6、IL-8)和抗炎CK(IL-2、IL-10)以及补体C3、C4的水平;同时记录机械通气时间、ICU在室时间及术后住院时间。结果对照组和CPB组术前cTnT和hs-CRP的测定结果均在正常范围内。CPB组术后即刻、24h、48h和72h各时相cTnT均显著性增高,其中以术后即刻增高最为显著(P<0.01),术后72h以后趋于正常;hs-CRP于术后24h开始显著性增高,至72h后逐渐降低(P<0.01)。CPB组患者血清补体C3水平在术后即刻显著低于术前水平,术后48h恢复并显著高于术前水平(P<0.01);血清补体C4水平在术后即刻显著低于术前水平,术后72h恢复并显著高于术前水平(P<0.01)。CPB组患者血清TNF-α水平于术后即刻明显增加并持续到术后24h,而后逐渐下降至术后48h恢复到术前水平;血清IL-6水平在术后24h出现高峰,术后48h后降至术前水平;血清IL-8于术后即刻明显增加,术后24h达高峰,并持续到术后72h;血清IL-2水平于CPB术后即刻明显增加,于术后24h基本恢复至术前水平;血清IL-10水平亦于CPB术后即刻逐渐升高,至术后24h达峰值,在术后48h仍较高。结论CPB围术期动态监测cTnT、hs-CRP、促炎和抗炎CK、补体C3、C4水平的变化,对加强CPB术后病人的监护具有十分重要的指导意义。更多还原

【Abstract】 Purpose To explore the clinical value of determination of the kinetic levels of serum cardiac troponin T （cTnT）, hypersensitive C-reactive protein （hs-CRP）, cytokine （CK）, complement 3 （C₃） and complement 4 （C₄） during perioperation of cardiopulmonary bypass （CPB） surgery. Methods Serum cTnT, hs-CRP, proinflammatory CK （TNF-α, IL-6, IL-8） and anti-inflammatory CK （IL-2,IL-10） and C₃, C₄ were determined in 20 patients with CPB and 10 patients without CPB before and after the surgery （0, 24 h, 48 h and 72 h respectively）. At the same time, the interval duration of mechanical assisted ventilation, postoperative ICU custodial monitoring and hospitalization after CPB surgery were recorded. Results cTnT and hs-CRP were in normal range in CPB group and control group before the surgery. After surgery the level of cTnT rosed and reached its peak at post-operation instantly （P<0.01）, and returned normal after 72 h in CPB group; the level of hs-CRP began to increase at 24 h and declined gradually after 72 h （P<0.01） in CPB group; C₃ decreased markedly after the CPB cardiac surgery, significantly lower than those before the surgery in CPB group, and the levels of C₃ returned to certain range after post-operation 48 h which were even much higher than those before the surgery （P<0.01）; C₄ also decreased markedly after the surgery, which was significantly lower than those before the surgery in CPB group, and the levels of C₄ returned to certain range after post-operation 72 h which was even much higher than those before the surgery（P<0.01）. There was no significant difference in these parameters in control group. In CPB group, TNF-α increased markedly after the CPB cardiac surgery to post-operation 24 h, which returned to normal range after post-operation 48 h; IL-6 increased markedly after post-operation 24 h, which returned to normal range after post-operation 48 h; IL-8 increased to peak levels after post-operation 24 h, which increased markedly after post-operation 72 h. IL-2 increased markedly after the CPB cardiac surgery, which returned to normal range after post-operation 24 h, and IL-10 increased markedly after post-operation 48 h in CPB group. Conclusions There is important direction significance for reinforcing custodial monitor and treatment after CPB surgery to determine the kinetic levels of serum cTnT, hs-CRP, proinflammatory and anti-inflammatory CK, C₃, C₄ during perioperation of CPB Surgery.更多还原