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目的 观察小儿体外循环术中、术后细胞因子肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 6、IL 8的变化 ,评价抑肽酶对体外循环炎性反应的抑制作用。方法 19例在体外循环下行心内直视手术的先天性心脏病病儿 ,随机分为 2组。试验组 10例 ,于转机过程中加入抑肽酶 4～ 5万KIU kg;对照组 9例 ,未用抑肽酶。分别于麻醉后、升主动脉阻断后 10min、停机后 10min、停机后 2 4h共 4个时点采取动脉血。酶标免疫放射法分别测定IL 6、IL 8、TNF α。结果 对照组IL 6、IL 8、TNF α于体外循环开始后升高 ;IL 8、TNF α于术后 2 4h恢复至基础值。试验组TNF α各时间点升高不明显 ,IL 6、IL 8升高幅度低于对照组 (P <0 0 1、0 0 5 )。结论 抑肽酶可能降低体外循环术后IL 6、IL 8、TNF α等细胞因子水平 ,从而减轻炎性反应
Objective To observe the changes of tumor necrosis factor (TNF) α, interleukin (IL) 6 and IL 8 after cardiopulmonary bypass (CPB) in children and evaluate the inhibitory effect of aprotinin on the inflammatory reaction during cardiopulmonary bypass. Methods Nineteen children with congenital heart disease undergoing cardiopulmonary bypass were randomly divided into two groups. The experimental group of 10 cases, during the transfer of aprotinin 4 to 50000 KIU kg; control group of 9 patients, without aprotinin. Respectively after anesthesia, ascending aorta block 10min, down 10min, down 24h after a total of 4 points to take arterial blood. Enzyme immunoassay was used to determine IL 6, IL 8 and TNF α. Results The levels of IL-6, IL-8 and TNF-alpha in control group increased after cardiopulmonary bypass. The levels of IL-8 and TNF-alpha returned to basal level at 24 hours after operation. In the experimental group, TNFα was not significantly increased at different time points, and the increase of IL 6 and IL 8 in the experimental group was lower than that of the control group (P <0.01,05). Conclusions Aprotinin may reduce the levels of IL-6, IL-8, TNF-alpha and other cytokines after cardiopulmonary bypass and thus reduce the inflammatory response