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目的:探讨婴幼儿体外循环术后心肌损害机理及平衡超滤联合改良超滤对心肌保护效果。方法:60例先天性心脏病患儿随机分为对照组(C)、改良超滤组(M)和平衡超滤联合改良超滤组(U)。M组在转流结束后应用改良超滤,U组在转流开始后进行平衡超滤,转流结束后进行改良超滤。分别在转流前(T1)、转流结束后20min(T2)、术后2h(T3)、术后6h(T4)、术后12h(T5)和术后24h(T6)测量动脉血中白介素6(IL-6)、肿瘤坏死因子(TNF-α)、黏附因子(sICAM-1)及丙二醛(MDA)、超氧化物歧化酶(SOD)、磷酸激酶同工酶(CK-MB)、肌酐蛋白(CTn-1)、脑利钠肽(BNP)的浓度。结果:IL-6、TNF-α及sICAM-1体外循环术后浓度三组均明显升高,U组的IL-6、TNF-α及sICAM-1浓度明显低于M组和C组。SOD体外循环术后浓度三组均降低,U和M组较C组降低明显;MDA体外循环术后浓度C和M组增高,U组无明显增高;CTn-1、CK-MB体外循环术后血浆浓度三组均较术前增高,U和M组较C组增高明显;BNP体外循环术后血浆浓度U和M组较术前明显降低,U组和M组明显低于C组。结论:婴幼儿体外循环术后心肌损害可能与大量炎性细胞因子释放及心肌再灌注损伤有关。联合应用平衡超滤和改良超滤可降低血浆中的炎性因子及脑利钠肽的浓度,对减轻心脏负荷、改善心脏功能有一定作用,但无明显减轻心肌急性损伤作用。
Objective: To investigate the mechanism of myocardial damage after cardiopulmonary bypass (CPB) in infants and young children and the effect of balanced ultrafiltration combined with modified ultrafiltration on myocardial protection. Methods: Sixty children with congenital heart disease were randomly divided into control group (C), modified ultrafiltration group (M) and balanced ultrafiltration plus modified ultrafiltration group (U). In group M, modified ultrafiltration was applied after the end of the commutation, group U was subjected to balanced ultrafiltration after the start of the commutation, and modified ultrafiltration was performed after the end of the commutation. The levels of interleukin (IL-6) in arterial blood were measured before treatment (T1), 20 min (T2) after operation, 2h after operation (T3), 6h after operation (T4), 12h after operation (T5) 6, TNF-α, sICAM-1, MDA, CK, CK-MB, , Creatinine protein (CTn-1) and brain natriuretic peptide (BNP). Results: The concentrations of IL-6, TNF-α and sICAM-1 after cardiopulmonary bypass were significantly increased in all three groups. The concentrations of IL-6, TNF-α and sICAM-1 in U group were significantly lower than those in M and C groups. The concentration of SOD in C group and M group increased after cardiopulmonary bypass and the level of SOD in U group was lower than that of C group Plasma concentrations of three groups were higher than preoperative, U and M group increased significantly compared with the C group; plasma concentrations of BNP after cardiopulmonary bypass U and M group was significantly lower than the preoperative, U and M group was significantly lower than the C group. Conclusion: Myocardial damage after cardiopulmonary bypass in infants may be related to the release of a large number of inflammatory cytokines and myocardial reperfusion injury. Combined application of balanced ultrafiltration and modified ultrafiltration can reduce the plasma levels of inflammatory cytokines and brain natriuretic peptide, to reduce the heart load, improve cardiac function has a certain effect, but did not significantly reduce the acute myocardial injury.