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目的研究通过一些炎症、补体等指标的测定及临床效果来评价PMEA(Poly2methoxyethylacrylate)涂层管道在小婴儿体外循环手术中的生物相容性,为临床应用提供依据。方法将接受体外循环下修补的20例大型室间隔缺损合并肺动脉高压患儿随机分为PMEA涂层管道组(A组)和非涂层组(B组),每组10例。两组患儿一般资料相仿。所有患儿均在麻醉成功开胸前(T1)、体外循环30min(T2)、体外循环结束鱼精蛋白中和后(T3)、术后4h(T4)和术后24h(T5)5个时间点采取动脉血,测定血常规、C反应蛋白、白介素(IL)1B、IL-6、IL-8、IL-10、TNF-α、补体C3a、C5a、D二聚体和凝血功能。术前、术后24小时常规测定肝肾功能、白球蛋白及电泳、cTnI值,并进行术后机械通气时间、术后24h尿量、心包引流量、血制品用量、ICU滞留时间及术后肺功能比较。结果术后即刻、4h血小板计数A组明显高于B组(P<0.05)。各时间点白细胞计数、白介素(IL)-10、TNF-α无明显差异。IL-6在术后4h和24h、C反应蛋白、IL-1β、IL-8在术后24hA组升高低于B组(P<0.05)。补体C3a、C5a两组相仿,凝血功能测定术后即刻Fib含量A组高于B组(P<0.05)。术后肝肾功能两组相仿;而cTnI A组升高低于B组(P= 0.023)。术后机械通气气道峰压A组低于B组,术后肺功能好于B组。术后尿量、机械通气时间、ICU滞留时间相仿。A组心包引流量及血制品用量少于B组(P<0.05)。结论PMEA涂层体外循环管道具有良好的生物相容性,具有减轻体外循环诱发的全身炎症反应和保护血小板的作用,临床上体现出良好的结果和对肺功能的保护。
Objective To evaluate the biocompatibility of PMEA (Poly2methoxyethylacrylate) coated tubes during cardiopulmonary bypass in infants and to provide basis for clinical application through the determination of some indicators such as inflammation and complement and clinical effects. Methods Twenty children with large ventricular septal defect and pulmonary hypertension undergoing cardiopulmonary bypass were randomly divided into PMEA-coated group (group A) and non-coated group (group B), with 10 in each group. The two groups of children with similar general information. All patients were anesthesia in the successful thoracotomy (T1), cardiopulmonary bypass 30min (T2), after end of proton and cardiopulmonary bypass (T3), 4h (T4) and 24h (T5) after 5 times The arterial blood was taken and the blood routine, C-reactive protein, interleukin (IL) 1B, IL-6, IL-8, IL-10, TNF-α, complement C3a, C5a, D dimer and coagulation function were measured. Preoperative and postoperative 24 hours routine determination of liver and kidney function, white blood globulin and electrophoresis, cTnI value, and postoperative mechanical ventilation time, 24h urine output, pericardial drainage, blood product dosage, ICU retention time and postoperative lung Function comparison. Results Immediately after operation, platelet count in group A at 4 hours was significantly higher than that in group B (P <0.05). The white blood cell count, interleukin (IL) -10 and TNF-α had no significant difference at all time points. The levels of C-reactive protein, IL-1β, and IL-8 in IL-6 at 24h and 24h after operation were significantly lower than those in group B at 4h and 24h after operation (P <0.05). Complement C3a, C5a two groups were similar, coagulation test immediately after Fib content A group was higher than the B group (P <0.05). The postoperative liver and kidney function were similar between the two groups; while the cTnI A group was lower than the B group (P = 0.023). Postoperative mechanical ventilation peak pressure A group was lower than the B group, postoperative pulmonary function is better than the B group. Postoperative urine output, mechanical ventilation time, ICU retention time similar. A group of pericardial drainage and blood products use less than the B group (P <0.05). Conclusion PMEA-coated extracorporeal circulation catheters have good biocompatibility, reduce the systemic inflammatory response induced by cardiopulmonary bypass and protect platelets, and have good clinical results and protection of lung function.