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目的探讨零平衡超滤对行体外循环(CPB)的婴幼儿体内炎性因子浓度的影响。方法选择2012年7月至2013年5月在北京协和医学院阜外医院心脏外科接受手术的简单轻症先天性心脏病患儿60例,心功能Ⅰ~Ⅱ级;其中男性29例,女性31例;年龄212~1 783 d,平均年龄658 d。随机分为平衡超滤组(BUF)和非平衡超滤组(n BUF)。分别于CPB前、超滤前、CPB结束后采集血液和超滤液标本。使用酶联免疫吸附分析检测白细胞介素(IL)-1、IL-6、IL-10、中性粒细胞弹性蛋白酶(NE)及肿瘤坏死因子(TNF)-α浓度。结果共纳入46例患儿,男性22例,女性24例;年龄212~1 783 d,平均年龄601 d。其中BUF组20例,n BUF组26例。停CPB后,所有炎性因子的血浆质量浓度较超滤前显著升高(P<0.05);两组血浆IL-1、IL-6、NE质量浓度差异无统计学意义(P>0.05);BUF组血浆IL-10、TNF-α质量浓度低于n BUF组(P<0.05)。尽管两组滤液中各种炎性因子质量浓度差异无统计学意义(P>0.05),但是滤液中各炎性因子总量BUF组大于n BUF组(P<0.05)。清醒时间及机械通气时间两组间差异无统计学意义。结论零平衡超滤可选择性增加滤除血浆中的炎性因子,但是并未改善简单轻症先天性心脏病患儿的临床预后。
Objective To investigate the effect of zero balance ultrafiltration on inflammatory cytokines in infants and young children undergoing cardiopulmonary bypass (CPB). Methods From July 2012 to May 2013, 60 children with simple mildly congenital heart disease undergoing cardiothoracic surgery at Fuwai Hospital, Peking Union Medical College Hospital were included in this study. Their cardiac function was grade Ⅰ ~ Ⅱ, including 29 males and 31 females Cases; age 212 ~ 1783 d, the average age of 658 d. Randomly divided into balanced ultrafiltration group (BUF) and non-equilibrium ultrafiltration group (n BUF). Blood samples and ultrafiltrate samples were collected before CPB, before ultrafiltration and after CPB. The concentrations of interleukin (IL) -1, IL-6, IL-10, neutrophil elastase (NE) and tumor necrosis factor (TNF) -α were measured by enzyme-linked immunosorbent assay. Results A total of 46 children were enrolled, including 22 males and 24 females, ranging in age from 212 to 783 days (mean, 601 days). Among them, 20 cases in BUF group and 26 cases in n BUF group. After stopping CPB, the plasma concentrations of all the inflammatory factors were significantly higher than those before ultrafiltration (P <0.05). There was no significant difference in plasma IL-1, IL-6 and NE concentrations between the two groups (P> 0.05). The plasma concentrations of IL-10 and TNF-α in BUF group were lower than those in n BUF group (P <0.05). Although there was no significant difference in the concentrations of various inflammatory cytokines between the two groups (P> 0.05), the total amount of inflammatory cytokines in the filtrate was larger than that in the n BUF group (P <0.05). There was no significant difference between the two groups in awake time and mechanical ventilation time. Conclusion Zero-balance ultrafiltration can selectively increase the plasma levels of inflammatory cytokines, but does not improve the clinical outcome of children with simple-mild congenital heart disease.