The Effect Of Operation On Beating Heart With Mild Hypothermic CPB On Systemic Inflammatory Reaction

To study the inhibiting effect on excessive systemic inflammation reaction in open heart operation with heart beating and mild hypothermia. Method: Patients were divided into two groups: 10 patients in experimental group and 8 patients in control group. Control group: superior vena cava (SVC) and inferior vena cava (IVC) were banded and ascending aorta was crossclamped when CBP had been established. Then cardiac standstill was achieved by perfusing cardioplegic solution; Experimental group: CBP was established as usual and heart was kept in beating mode during mild hypothermic CBP. Plasma levels of TNF-a, interleukin-6, and interleukin-8 were measured simultaneously in peripheral arterial blood and coronary sinus blood at 5 time points. Plasma levels of interleukin-10 were measured simultaneously in peripheral arterial blood and inferior vena cava (IVC) at 3 time points. And neutrophil was measured in peripheral arterial blood and coronary sinus blood at 3 time points. After operation, the dose of dupamine was observed. Results: The number of neutrophils was significantly higher in peripheral artery sample than in coronary sinus sample in contrast group since 15 mimutes after artic declamping (p<0.05). But there was no difference in experimental group. In contrast group, the level of interleukin-6 and interleukin-8 was significantly higher in coronary sinus sample than in peripheral artery at 2 hours after aortic declamping (p<0.05). But there was no difference in experimental group. The level of interleukin-10 was significantly higher in inferior vena cava (IVC) blood than in peripheral artery blood in both two groups since 30 minutes during CPB (p<0.05). And the level of interleukin-10 of inferior vena cava was much higher at 120 minutes after declamping in experimental group than in contrast group(p<0.05). The dosage of dopamine in experimental group was increased as compared with that in control group. As to TNF-a, there is no difference between peripheral artery and coronary sinus blood in these two groups. In control group, TNF-a, interleukin-10 and interleukin-6 all had closely relationship with the rate of heart to thorax. But there isn't such relationship in experimental group. Conclusion: Theoperation on beating heart during mild hypothermic CPB had a better result in restraining the heart to release proinflammatory cytokines such as IL-6,IL-8 and resulting in a less serious excessive systemic inflammation reaction with CPB. It had a better protection for heart and systemic organs during CPB.