摘要目的 观察库存悬浮红细胞应用血液回收机洗涤及零平衡超滤两种不同方法处理后预充对婴幼儿体外循环后炎症因子水平及肺功能的影响.方法 选取室间隔缺损择期手术患儿60例,随机分成对照组A、试验组B和试验组C.A组对体外循环预充用库存悬浮红细胞不进行任何处理,B组应用血液回收机对库存悬浮红细胞进行洗涤处理后再预充,C组对库存悬浮红细胞进行体外循环前零平衡超滤.分别在体外循环开始前(T1)、结束时(T2)、术后2 h(T3)、12 h(T5)、24 h(T7)取动脉血标本行肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-8、IL-10检测,比较3组之间差异;计算并比较3组患儿T1、T2、术后6 h(T4)、T5和术后18 h(T6)时的肺静态顺应性、气道阻力、氧合指数、肺泡动脉氧分压差;比较3组患儿机械通气时间及ICU监护时间的差异.结果 两试验组TNF-α、IL-6、IL-8、IL-10在T2、T4、T5显著低于对照组(P＜0.05),在上述相同时间点B组各指标显著低于C组(P＜0.05);对照组肺静态顺应性、氧合指数在T2、T3、T4显著低于两试验组(P＜0.05),其中相同时间点相同指标C组显著低于B组(P＜0.05),试验组气道阻力、肺泡动脉氧分压差在T2、T3、T4、T5显著低于对照组(P＜0.05),上述相同时间点相同指标B组显著低于C组(P＜0.05);B组和C组术后机械通气时间及监护室监护时间显著低于A组(P＜0.05),其中B组以上两指标显著低于C组(P＜0.05).结论 应用血液回收机洗涤和零平衡超滤对婴幼儿体外循环预充用库存悬浮红细胞进行处理,均可降低体外循环后炎症因子水平,改善术后肺功能,缩短机械通气时间及ICU监护时间,两者相比血液回收机洗涤处理的效果更好.

abstractsObjective Observe the influence of processing of banked red blood cells (RBCs) with cell saver compared with zero-balanced ultrafiltration(Z-BUF) on the inflammatory factor levels and lung function after cardiopulmonary bypass (CPB) in infants.Methods 60 infants with ventricular septal defect were randomly divided into control group (A),experimental group(B) and experimental group(C).Banked RBCs washed with cell saver before priming in B,in C the banked RBCs were treatment with Z-BUF and in A the banked RBCs primed directly without any treatment.The levels of tumor necrosis factor(TNF-α),interlecukin-6(IL-6),interlecukin-8(IL-8) and interlecukin-10(IL-10) in arterial blood were decected and comparative analyze the differences between and among three groups.The lung functional parameters,mechanical ventilation time and ICU monitoring time at specific time points of three groups were measured and compared.Results The levels of TNF-α,IL-6,IL-8,IL-10 after CPB in B and C were significantly lower than that in group A(P ＜0.05),between B and C,the levels of inflammatory factors in B were more lower(P ＜0.05).The functional parameters post-CPB of B and C were significantly improved compared with A(P ＜ 0.05) and the B and C's mechanical ventilation time,ICU monitoring time were more shorter(P ＜ 0.05).B and C in comparison,the former lung functiona improved more obviously(P ＜ 0.05).Conclusion Treatment of banked RBCs with cell saver and Z-BUF can reduce the inflammatory factor levels after CPB in infants and relieve systemic inflammatory response,improve lung function,short mechanical ventilation time and ICU monitoring time,by comparison,the former is better than the latter.