老年瓣膜置换术患者体外循环对TNF-α、IL-6与中性粒细胞水平的影响

发布时间：2018-05-14 03:24

本文选题：瓣膜置换术 + 体外循环　；参考：《中国老年学杂志》2017年11期

【摘要】：目的探讨老年瓣膜置换术患者体外循环对肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6与中性粒细胞水平的影响。方法体外循环下行心脏瓣膜置换术患者60例,分别于建立体外循环前(T1)、建立后30 min(T2)、停机时(T3)及停机后2 h(T4)、6 h(T5)及24 h(T6)采集桡动脉血5 ml,采用酶联免疫吸附法(ELISA)测定血清TNF-α及IL-6水平,采用细胞分析仪测定全血中性粒细胞的数量;比较患者在不同时间各项指标的变化情况。结果血清TNF-α水平在T1时刻最低,于T2时刻开始升高,于T4时刻达到峰值,之后逐渐开始下降(T5),并于T6时刻再一次升高,但仍显著高于T1时刻(P0.05);血清IL-6水平在建立体外循环后迅速上升,于T5时刻达到高峰,之后开始下降,但T6时刻仍显著高于T1水平(P0.05);中性粒细胞数量在体外循环建立后出现升高,于T4时刻达到高峰,之后出现下降(T5),于T6时刻再一次升高(P0.05);血清TNF-α峰值水平与体外循环时间、主动脉阻断时间均呈正相关关系(r=0.631,0.657;P0.05);血清IL-6峰值水平与体外循环时间、主动脉阻断时间均呈现正相关关系(r=0.535,0.609;P0.05)。结论体外循环可促进外周血中性粒细胞数量、血清TNF-α及IL-6水平升高,引发全身炎症反应;体外循环时间、主动脉阻断时间越长越加重TNF-α、IL-6的释放,加重术后炎性反应。
[Abstract]:Objective to investigate the effects of cardiopulmonary bypass (CPB) on tumor necrosis factor TNF- 伪, interleukin-6 (IL-6) and neutrophils in elderly patients undergoing valve replacement. Methods 60 patients with cardiac valve replacement were treated with cardiopulmonary bypass. The radial artery blood samples were collected before CPB, 30 min after CPB, 30 min after CPB, T3 at downtime (T3), 2 h after CPB (T5) and 24 h T6 (T6). Serum TNF- 伪 and IL-6 levels were measured by enzyme linked immunosorbent assay (Elisa). The number of neutrophils in whole blood was measured by cell analyzer, and the changes of various indexes at different time were compared. Results the serum TNF- 伪 level was lowest at T1, began to increase at T2, reached its peak at T4, then began to decrease gradually, and increased again at T6. The level of serum IL-6 increased rapidly after CPB was established, reached its peak at T5, then began to decrease, but at T6 it was still significantly higher than that at T1, and the number of neutrophils increased after CPB. The peak value of serum TNF- 伪 and the time of aortic occlusion were positively correlated with the time of cardiopulmonary bypass (CPB), the peak level of serum IL-6 and the time of cardiopulmonary bypass (CPB), the peak level of serum TNF- 伪 and the time of cardiopulmonary bypass (CPB). There was a positive correlation between the aortic clamping time and the time of aortic occlusion. Conclusion Cardiopulmonary bypass can increase the number of neutrophils, increase the levels of serum TNF- 伪 and IL-6, and induce systemic inflammation, and the longer the duration of CPB, the more TNF- 伪 IL-6 release and the more inflammatory response after CPB.
【作者单位】：贵阳中医学院第二附属医院心胸外科;广东省医学科学院心血管病研究所;贵阳中医学院第二附属医院麻醉科;
【基金】：国家自然科学基金(No.81260020) 贵州省科学技术基金(No.黔科合J字[2009]2165号)
【分类号】：R654.2

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