| During cardiopulmonary bypass (CPB), blood first contacts the foreign surface of the extracorporeal circuit, ischemia of organs and reperfusion injury, lead to activate the blood, including polymorphonuclear leukocyte, platelet, coagulation, kinin, and complement systems. And inflammatory radiators release, the systemic inflammatory response is initiated. The mediators are main materials which elicit inflammatory response and organ injury. The behavior of cytokine production, mainly including tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-1 receptor antagonist (IL-lra) during and after CPB, is understood. If the activated inflammatory response were out of control, and did not treated effectively, the multiple organs failure will be the result. The treatment consists in reducing the amount of pro-inflammatory cytokines (TNF-a, IL-6, IL-8) or increasing the amount of anti-inflammatory cytokines (IL-10). Up till now, ultrafiltration, membrane oxygenator, and heavy dose of aprotinin are clinical effective treatment.At the present time, ultrafiltrator of polysulphone (PS) membrane is the most of use in cardiovascular surgery. It is mainly used to filtrating water, concentrating blood, and eliminating inflammatory mediators of low and middle molecules also. In generally, methods of ultrafiltration include conventional ultrafiltration (CUF), balanced ultrafiltration (BUF), and modified ultrafiltration (MUF). Clearance of molecular weight over middle molecules, such as IL-6 and trimeric TNF-a, is in dispute. Especially, a rise in plasma levels of cytokines may be occurred after hemoconcentration with MUF. In recent years, studies indicated the clearance of cytokine mainly-11-depends on its absorption to membrane. Among various membranes, polyacrylonitrile (AN69) has highest capacity of absorption. And the capacity of polysuphone (PS) is evidently lower than that of AN69. They all can remove inflammatory mediators of low and middle molecules, such as C33, mainly by convection or filtration.The facts mentioned above, inflammatory response to CPB is closely related to rise in plasma of cytokine levels. Ultrafiltrator of PS membrane, which is the most of clinical user in cardiovascular surgery, lacks of adequate capacity of removal to cytokines. AN69 membrane has higher capacity of removal to cytokines than PS membrane. Nevertheless, ultrafiltrator of AN69 membrane is not used during CPB widely. Therefore, we investigated the changes in plasma of cytokines, clinic manifestation of inflammatory response to CPB and its effect on postoperative respiratory function, comparing ultrafiltration with AN69 membrane and with PS membrane. The effect and mechanism of ultrafiltration with the two membranes alleviating inflammatory response to CPB were discussed. There is no similar article reporting.Part 1 Effect of balanced ultrafiltration with different membranes during cardiopulmonary bypass on plasma levels of cytokinesObjective: The study is to investigate the levels of cytokines in plasma by comparing ultrafiltration with AN69 membrane and with PS membrane, supply the evidence of ultrafiltration with AN69 membrane more effectively removes cytokines in plasma than with PS membrane.Methods: 1. Forty patients with rheumatic heart disease, 22 male, 18 female, age ranged from 22 to 47 years, body weight ranged from 42 to 65kg, underwent mitral replacement operation with CPB and were randomly divided into AN69 group (n=15), PS group(n=15) and control group(n=10). AN69 group was ultrafiltrated with AN69 membrane; PS group was ultrafiltrated with PS membrane and control group without ultrafiltrationduring CPB. 2. The setting of ultrafiltration bypassed CPB circuit. Ultrafiltration began at the time of CPB rewarming and finished at the end of CPB, the time of ultrafiltration was controlled in 30 to 45 min, and the amount of ultrafiltrate was 1500 to 2500ml. In the early time, zero-balanced ultrafiltration (Z-BUF) was used, and hematocrit was required... |
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