七氟烷预处理对小儿体外循环后肠黏膜屏障功能的影响

摘要

Objective To investigate the effect of sevoflurane pretreatment on intestinal mucosal barrier function during cardiopulmo-nary bypass( CPB) in pediatric patients.Methods Thirty infants undergoing open heart repair of ventricular septal defect and atrial septal defect under CPB,they were randomly divide into two groups with 15 case each :sevoflurane group(group S),control group ( group C) respectively.2%sevoflurane was inhaled after central venous catheter until CPB beginning in group S whereas group C was given no inhalation anesthetic.Jugular vein blood was taken at 5 time points:before CPB(T1),immediately at the end of CPB(T2),2h after CPB( T3 ) ,6 h after CPB( T3 ) ,and 24 h after CPB( T5 ) ,and defected the concentration of I-FABP,DAO,IL-6 and TNF-α. Results Comparing between two groups,there were no significantly difference in the concentration of I-FABP,DAO,IL-6 and TNF-αbefore CPB(T1)(P>0.05).Comparing with T1,the concentrations of I-FABP,DAO,IL-6 and TNF-αwere all increased sig-nificantly at T2 ,T3 ,T3 ,T5 ( P<0.05) .In group S,the concentrations of I-FABP,DAO,IL-6 and TNF-αwere significantly lower at T2,T3,T3,T5,than those in group C(P<0.05).Conclusions (1)The intestinal mucosal barrier function was impaired in the pediat-ric cardiac surgery after cardiopulmonary bypass indicates.(2)2% sevoflurane pretreatment possibly has inhibitory effect on systemic inflammatory response during CPB and possibly had a protective effect on intestinal mucous membrane barrier.%目的：评价围体外循环期七氟烷预处理对肠道黏膜屏障功能的影响。方法选取择期在体外循环下行心内直视房间隔缺损和室间隔缺损修补术的患儿30例，随机分为七氟烷预处理组（ S组）和对照组（ C组），每组15例。 S组在中心静脉成功置管后开始吸入浓度2％的七氟烷至CPB开始，C组不给任何吸入麻醉药。在CPB前（ T1）、停止CPB后即刻（ T2）、CPB结束后2h（T3）、CPB结束后6 h（T4）和CPB结束后24 h（T5）五个时间点分别抽取中心静脉血标本，测量血清中肠脂肪酸结合蛋白（I-FABP）、二胺氧化酶（DAO）、白介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的浓度。结果两组患儿CPB前（T1）的I-FABP、DAO、IL-6和TNF-α的血清浓度无显著性差异（P＞0．05），与CPB前（T1）相比较，两组患儿CPB停止后各时间点的I-FABP、DAO、IL-6和TNF-α的血清浓度均显著升高，有统计学差异（P＜0．05），S组的I-FABP、DAO、IL-6和TNF-α的血清浓度在CPB停止后各时间点均较C组降低，差异有统计学意义（P＜0．05）。结论（1）小儿体外循环心脏外科手术中有肠黏膜屏障功能的受损。（2）2％七氟烷预处理对围体循期炎症反应可能有抑制作用，对肠黏膜膜屏障可能有保护作用。