The Effect Of Modified Ultrafiltration On Cytokines And Tissue Injury During The Peri-cardiopulmonary Bypass Period In Pediatric

Background and objective: The modern era of cardiac sugery began when the technique for cardiopulmonary bypass (CPB) was introduced in the early 1950s. Although it has been clearly shown that CPB is indispensable for most open heart operations, an undesirable systemic inflammatory response is associated with CPB. Many factors during CPB, either material dependent (the exposure of blood to nonphysiologic surfaces and conditions) or material independent (surgical trauma, ischemia-reperfusion to the organs, changes in body temperature, and release of endotoxin), have been well documented to induce a complex inflammatory response, including complement activation, release of cytokines, leukocyte activation along with the expression of adhesion molecules, and the production of various substances including oxygen-free radicals, arachidonic acid metabolites, platelet-activating factor (PAF), nitric oxide (NO), and endothelins. Cardiac surgery with CPB evokes systemic inflammatory response that, in uncomplicated case, is a temporary event representing a physiologic reaction to tissue injury. When the systemic inflammatory response is exaggerated, the postoperative course may be complicated by organ dysfunction, including respiratory failure, renal dysfunction, bleeding disorders, neurologic dysfunction, altered liver function, and ultimately, multiple system organ failure (MSOF). More recently, it has been shown that an anti-inflammatory response may also be initiated during and after CPB. This complex chain of events has strongsimilarities with sepsis.Cardiopulmonary bypass in children is associated with the accumulation of water as a consequence of an inflammatory capillary leak. That increase in total body water is associated with tissue edema and subsequent organ dysfunction, particularly in the heart, lungs, and brain. Previous studies have shown that modified ultrafiltration (MUF) after CPB in children is capable of removing excess extracellular fluid as well as some inflammatory mediators, and is thought to be responsible for improved clinical outcome after pediatric cardiac surgery , although the evidence for this is not clear. It remains to clarified if cytokines can be removed by using MUF and whether it entails a rebound release later in the postoperative period.The concentrations of these markers of inflammation and tissue injury were measured. This study attempted to determine the effect of modified ultrafiltration on cytokines and tissue injury during the peri-cardiopulmonary bypass period in pediatric.Methods: Twenty-two children with congenital heart disease and without liver and renal dysfunction were randomly divided into control group (group C) and modified ultrafiltration group (group M), blood samples were taken from radial artery before operation (Ti), at the cessation of CPB(T2), 20min after CPB (Ts), 6h (T4) and 24h after operation (Ts) to measure serum levels of tumor necrosis factor alpha (TNF-a), interleukin-8 (IL-8), interleukin-10 (IL-10), aspartate transaminase (AST) , creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactic dehydrogenase (LDH), hydroxybutyric dehydrogenase (HBDH) activity.Results: 1. All patients survived the surgery and were discharged in good condition. No complication directly attributable to the ultrafiltration were observed. There were no statistical significance in patient characteristics between control group and modified ultrafiltration group. The volumes of ultrafiltrate was 392.73 + 10.54ml.2. The levels of TNF- a in group M lower than group C significantly (P<0.05 ) . The levels of TNF- a increased significantly from the end of CPB to 6h after operation in group C (P<0.05 ) and reach peak level 20min after CPB (P<0.01), and there was no difference with baseline value 24h after operation (/)>0.05). There were noincrease in group M (P>0.05). The levels of TNF- a in group M lower than group C significantly from 20min after CPB to 6h after operation (P<0.05) . The levels of IL-8 increased significantly in both group from the...