• 西安交通大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院 心血管外科, 西安 710061;

目的 探討采用魚精蛋白-瓊脂糖凝膠進(jìn)行無肝素化體外循環(huán)(CPB)的可行性?!》椒ā∵x擇健康成年家犬12只,犬齡2~3歲,雌雄不限,體重20~28(23.3±3.7) kg。按隨機數(shù)字表法將12只犬分為兩組,每組6只,肝素化組:行常規(guī)CPB;非肝素化組:采用魚精蛋白-瓊脂糖凝膠吸附血漿凝血因子,即行無肝素化CPB。于CPB開始時和CPB1 h、2 h、3 h采用酶聯(lián)免疫吸附法(ELISA)測定動脈血中腫瘤壞死因子α (TNF-α)、白細(xì)胞介素6 (IL-6)和白細(xì)胞介素8 (IL-8)的濃度,并進(jìn)行比較?!〗Y(jié)果 非肝素化組和肝素化組犬在CPB過程中肉眼觀察膜肺內(nèi)均未見血栓形成,全血激活凝血時間(ACT)始終>480 s,生命體征均平穩(wěn)。兩組血漿TNF-α、IL-6和IL-8濃度在CPB開始時差異無統(tǒng)計學(xué)意義,非肝素化組血漿TNF-α和IL-8于CPB 1 h、CPB 2 h和CPB 3 h時均高于肝素化組[CPB 3 h TNF-α:(156.48±16.65) ng/L vs.??(115.87±15.63) ng/L,t=4.356, P=0.001;CPB 3 h IL-8:(365.38±46.18)ng/L vs.??(299.29±34.50) ng/L, t=2.808, P=0.019],而兩組IL-6濃度差異無統(tǒng)計學(xué)意義(P>0.05)?!〗Y(jié)論 依靠魚精蛋白-瓊脂糖凝膠對凝血因子進(jìn)行吸附, 以進(jìn)行無肝素化CPB效果明確,但具有一定的促進(jìn)全身炎癥反應(yīng)效應(yīng)。

引用本文: 閆煬,閆路勤,耿希剛. 無肝素化體外循環(huán)轉(zhuǎn)流及早期炎性因子的表達(dá). 中國胸心血管外科臨床雜志, 2012, 19(4): 414-418. doi: 復(fù)制

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9.  Franke A, Lante W, Fackeldey V, et al. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures:is what we see what we know? Eur J Cardiothorac Surg, 2005, 28 (4):569-575.
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13.  Welters ID, Feurer MK, Preiss V, et al. Continuous S- (+)-ketamine administration during elective coronary artery bypass graft surgery attenuates pro-inflammatory cytokine response during and after cardiopulmonary bypass. Br J Anaesth, 2011, 106 (2):172-179.
14.  Morgan C, Zappitelli M, Gill P. Statin prophylaxis and inflammatory mediators following cardiopulmonary bypass:a systematic review. Crit Care, 2009, 13 (5):R165.
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16.  余楊, 何德沛, 申林, 等. 核轉(zhuǎn)錄因子-κB抑制劑對體外循環(huán)肺損傷的保護(hù)作用. 中國胸心血管外科臨床雜志, 2007, 14 (5):86-88.
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  2. 2.  Greinacher A. Treatment of heparin-induced thrombocytopenia. Thromb Haemost, 1999, 82 (2):457-467.
  3. 3.  Levy JH, Adkinson NF Jr. Anaphylaxis during cardiac surgery:implications for clinicians. Anesth Analg, 2008, 106 (2):392-403.
  4. 4.  Parker JT, Beutler DS, Sukavaneshvar S, et al. Mitigation of coagulation by removing clotting factors part 1:In vitro feasibility study. ASAIO J, 2007, 53 (4):415-420.
  5. 5.  Sukavaneshvar S, Parker JT, Beutler DS, et al. Mitigation of coagulation by removing clotting factors part 2:Heparin-free extracorporeal circulation in a porcine model. ASAIO J, 2007, 53 (4):421-427.
  6. 6.  Wan S, Leclerc JL, Vincent JL. Cytokine responses to cardiopulmonary bypass:lessons learned from cardiac transplantation. Ann Thorac Surg, 1997, 63 (1):269-276.
  7. 7.  Taylor KM. SIRS--the systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg, 1996, 61 (6):1607-1608.
  8. 8.  Tilg H, Dinarello CA, Mier JW. IL-6 and APPs:anti-inflammatory and immunosuppressive mediators. Immunol Today, 1997, 18 (9):428-432.
  9. 9.  Franke A, Lante W, Fackeldey V, et al. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures:is what we see what we know? Eur J Cardiothorac Surg, 2005, 28 (4):569-575.
  10. 10.  Huang H, Yao T, Wang W, et al. Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116 (10):1504-1507.
  11. 11.  王電軍, 尹邦良, 喻風(fēng)雷, 等.間斷肺通氣對體外循環(huán)肺損傷的保護(hù)作用.中國胸心血管外科臨床雜志, 2005, 12 (2):86-88..
  12. 12.  Guo HW, Wang WJ, Liao CX, et al. Effect of inhaling specific phosphodiesterase inhibitor on lung injury induced by cardiopulmonary bypass. Zhonghua Yi Xue Za Zhi (Taipei), 2011, 91 (20):1401-1404.
  13. 13.  Welters ID, Feurer MK, Preiss V, et al. Continuous S- (+)-ketamine administration during elective coronary artery bypass graft surgery attenuates pro-inflammatory cytokine response during and after cardiopulmonary bypass. Br J Anaesth, 2011, 106 (2):172-179.
  14. 14.  Morgan C, Zappitelli M, Gill P. Statin prophylaxis and inflammatory mediators following cardiopulmonary bypass:a systematic review. Crit Care, 2009, 13 (5):R165.
  15. 15.  Martínez-Comendador JM, Alvarez JR, Mosquera I, et al. Preoperative statin treatment reduces systemic inflammatory response and myocardial damage in cardiac surgery. Eur J Cardiothorac Surg, 2009, 36 (6):998-1005.
  16. 16.  余楊, 何德沛, 申林, 等. 核轉(zhuǎn)錄因子-κB抑制劑對體外循環(huán)肺損傷的保護(hù)作用. 中國胸心血管外科臨床雜志, 2007, 14 (5):86-88.