本文選題：瓣膜置換術 + 體外循環(huán)�。� 參考：《中國老年學雜志》2017年11期

【摘要】：目的探討老年瓣膜置換術患者體外循環(huán)對腫瘤壞死因子(TNF)-α、白細胞介素(IL)-6與中性粒細胞水平的影響。方法體外循環(huán)下行心臟瓣膜置換術患者60例,分別于建立體外循環(huán)前(T1)、建立后30 min(T2)、停機時(T3)及停機后2 h(T4)、6 h(T5)及24 h(T6)采集橈動脈血5 ml,采用酶聯(lián)免疫吸附法(ELISA)測定血清TNF-α及IL-6水平,采用細胞分析儀測定全血中性粒細胞的數(shù)量;比較患者在不同時間各項指標的變化情況。結果血清TNF-α水平在T1時刻最低,于T2時刻開始升高,于T4時刻達到峰值,之后逐漸開始下降(T5),并于T6時刻再一次升高,但仍顯著高于T1時刻(P0.05);血清IL-6水平在建立體外循環(huán)后迅速上升,于T5時刻達到高峰,之后開始下降,但T6時刻仍顯著高于T1水平(P0.05);中性粒細胞數(shù)量在體外循環(huán)建立后出現(xiàn)升高,于T4時刻達到高峰,之后出現(xiàn)下降(T5),于T6時刻再一次升高(P0.05);血清TNF-α峰值水平與體外循環(huán)時間、主動脈阻斷時間均呈正相關關系(r=0.631,0.657;P0.05);血清IL-6峰值水平與體外循環(huán)時間、主動脈阻斷時間均呈現(xiàn)正相關關系(r=0.535,0.609;P0.05)。結論體外循環(huán)可促進外周血中性粒細胞數(shù)量、血清TNF-α及IL-6水平升高,引發(fā)全身炎癥反應;體外循環(huán)時間、主動脈阻斷時間越長越加重TNF-α、IL-6的釋放,加重術后炎性反應。
[Abstract]:Objective to investigate the effects of cardiopulmonary bypass (CPB) on tumor necrosis factor TNF- 偽, 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- 偽 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- 偽 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- 偽 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- 偽 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- 偽 and IL-6, and induce systemic inflammation, and the longer the duration of CPB, the more TNF- 偽 IL-6 release and the more inflammatory response after CPB.
【作者單位】： 貴陽中醫(yī)學院第二附屬醫(yī)院心胸外科;廣東省醫(yī)學科學院心血管病研究所;貴陽中醫(yī)學院第二附屬醫(yī)院麻醉科;
【基金】：國家自然科學基金(No.81260020) 貴州省科學技術基金(No.黔科合J字[2009]2165號)
【分類號】：R654.2

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