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目的观察婴儿体外循环(CPB)期间炎性反应过程中可溶性细胞粘附因子-1(s ICAM-1)、IL-8、肿瘤坏死因子α(TNF-α)变化规律及其与中性粒细胞肺内扣押程度、体外循环时间、主动脉阻断时间的相关性。方法选取2011年1月—2015年9月在河北工程大学附属医院行CPB下先天性心脏病(CHD)手术的30例患儿,患儿分别于CPB前(T_1)、CPB 40min(T_2)、CPB停机(T_3)及停机后2h(T_4)、6h(T_5)和24h(T_6)共6个不同时间点采用酶联免疫法(ELISA)测定血清TNF-α、IL-8、s ICAM-1水平,体外循环开始前及结束时取左右心房血测定中性粒细胞数值,计算中性粒细胞跨肺差值。将中性粒细胞跨肺差值与体外循环时间、主动脉阻断时间、s ICAM-1、TNF-α、IL-8的高峰浓度做相关性分析。结果 TNF-α、IL-8、中性粒细胞计数在T_2、T_3、T_4、T_5、T_6时间点高于T_1,差异有统计学意义(P<0.05)。CPB前后左右心房中性粒细胞跨肺差值比较,差异有统计学意义(P<0.05)。中性粒细胞跨肺差值与CPB时间、主动脉阻断时间、s ICAM-1、IL-8呈正相关(r=0.732、0.830、0.855、0.784,P<0.01)。围CPB期TNF-α与中性粒细胞呈正相关(r=0.209,P<0.05)。结论 CPB可引起炎性递质释放,导致中性粒细胞黏附滞留于未成熟肺内,产生肺炎性反应,细胞因子的变化与肺功能损伤存在相关性。
Objective To observe the changes of soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-8 and tumor necrosis factor-α (TNF-α) during inflammatory reaction in infantile cardiopulmonary bypass (CPB) Pulmonary sequestration, cardiopulmonary bypass time, aortic cross-correlation time. Methods Thirty children with congenital heart disease (CHD) under CPB at Hebei University of Engineering Hospital from January 2011 to September 2015 were enrolled in this study, Serum levels of TNF-α, IL-8 and s ICAM-1 were measured by enzyme-linked immunosorbent assay (ELISA) at 6 different time points after CPB shutdown (T_3), 2h (T_4), 6h (T_5) and 24h (T_6) Level, before and at the end of cardiopulmonary bypass, left and right atrial blood was taken to determine neutrophil numbers, and to calculate the difference in neutrophils across the lung. The correlation between the difference of PMNs and the time of cardiopulmonary bypass, the time of aorta block, s ICAM-1, TNF-α and IL-8 were analyzed. Results The levels of TNF-α, IL-8 and neutrophil were higher than T_1 at T_2, T_3, T_4, T_5 and T_6, the difference was statistically significant (P <0.05). CPB before and after atrial neutrophil across the lung difference, the difference was statistically significant (P <0.05). The difference between the neutrophils across the lung and CPB time, aortic cross-clamping time, s ICAM-1, IL-8 was positively correlated (r = 0.732,0.830,0.855,0.784, P <0.01). Peripheral CPB phase TNF-α and neutrophils were positively correlated (r = 0.209, P <0.05). Conclusion CPB can cause the release of inflammatory mediators, leading to neutrophil adhesion in immature lungs, resulting in a pneumonia reaction. The changes of cytokines are associated with lung injury.