Effect Of Disposable Blood Storage Filter On Inflammation And Liver And Kidney Function After Cardiopulmonary Bypass

Objective:The purpose of this study is to explore whether disposable use of blood storage filter can reduce the inflammatory reaction caused by CPB through the detection of inflammatory factors during and after operation,and to explore the effect of disposable use of blood storage filter on the recovery of liver and kidney function after operation by collecting postoperative laboratory indexes and comparing the change trend.Methods:A total of 101 patients underwent surgery（including valve replacement and congenital heart disease）under cardiopulmonary bypass（CPB）.The age of the patients ranged from 18 to 70 years old.The heart function was II-III（NYHA grade）before operation.The patients with coma,infection,failure of liver and kidney function and long-term use of hormones and immunosuppression were excluded.The101 patients were randomly divided into two groups:the experimental group（group E）was treated with disposable blood storage filter（n=50）,and the control group（group C）was not treated with disposable blood storage filter（n=51）.After entering the room,the patients were monitored by electrocardiogram,finger pulse oxygen,invasive arterial pressure and central venous pressure to induce anesthesia.After endotracheal intubation,volume-controlled mechanical ventilation was performed,oxygen flow was about 2L/min,and end-expiratory carbon dioxide was maintained at35～45mm Hg.Anesthesia was maintained with dexmetomidine 0.5～1.0 ug·kg^-1·h^-1,sufentanil 0.5～1.0 ug·kg^-1·h^-1,cis atracurium 0.1 mg·kg^-1·h^-1and sevoflurane 1%～3%during the operation.The depth of anesthesia was adjusted according to the bispectral index（BIS）,and the BIS value was maintained at 40～60.The operations were performed by the same group of personnel.In group E,a disposable blood storage filter was connected between the attractor and the membrane oxygenator.Pre-filling and operation were performed routinely.Venous blood 3ml was collected at six time points including pre-operation（T1）,the beginning of CPB（T2）,the end of CPB（T3）,the end of operation（T4）,24 hours after operation（T5）and 48 hours after operation（T6）.The concentrations of TNF-α,IL-6 and IL-10 were measured by enzyme linked immunosorbent assay（ELISA）at the above 6 time points.The blood routine,coagulation routine and liver and kidney function indexes of the two groups at T1,T4,T5 and T6 were collected and compared by t-test.Results:1.There was no difference in age,sex,operation mode,operation time,CPB time, ICU stay time,blood loss,blood transfusion,number of albumin users and urine volume during operation,24 hours after operation and 48 hours after operation between the two groups.And there was no difference in the incidence of hepatic, renal or cardiac insufficiency or preoperative laboratory indexes between group C and group E（P>0.05）.Two patients in each group were discharged automatically for social reasons,the rest were cured.2.The concentration of TNF-αin both groups began to increase from the beginning of operation,increased rapidly after CPB（T3）,reached a high concentration after operation（T4）and the first day after operation（T5）,and began to decrease on the second day after operation（T6）.The concentration of E group at T3,T4,T5 were lower than that of C group（P=0.019,0.001,0.042）,but there was no obviously difference at other time points（P>0.05）.3.The concentration of IL-6 in both groups increased from the beginning of CPB （T2）,reached the maximum value at the end of operation（T4）,then slowly decrease.The concentration of E group at T3,T5 were lower than that of C group （P=0.041,0.002）,but there was no difference at other time points（P>0.05）.4.The concentration of IL-10 in two groups became the maximum value after CPB （T3）,then began to go down.The concentration in group E was higher than the other one at the end of CPB（T3）（P=0.001）,but there was no obviously difference between them at other time points（P>0.05）.5.The level of alanine transferase in two groups was similar pre-operation,then appeared an upward after operation.There was statistical difference in alanine transferase between two groups at T6（P=0.001）,but no difference was appeared in other indexes at other points（P>0.05）.Conclusion:The use of disposable blood storage filter during cardiopulmonary bypass could reduce postoperative inflammatory reaction.;it might relieve postoperative liver function injury,but could not improve the function of renal.