Effect On Cytokine And Lung Function After Ultrafiltration Of Mitral Valve Replacement

Objective To study the effect on Cytokine and Lung function after Ultrafiltration of Mitral Valve Replacement, giving some basic theories on using ultrafiltration for the lung protection in reasonable on the clinic .Methods 30 patients undergoing mitral valve stenosis valve replacement were randomly assigned into ultrafiltration group and control group (15 caeses in each group). To the preoperative patients giving strong heart,diuresis therapy, improve cardiac function , actively preparation of the preoperative examation. There was no operative contraindication. Mitral Valve Replacement was given undergoning combined anesthesia and CPB . Serial arterial blood samples(4ml) were collected at the following intervals respectively: Prior to CPB (T1),30min after CPB(T2) and 0h(T3), 2h(T4), 6h(T5), 24h(T6) after the end of CPB. We also get the experiment group's filtrate 2 ml (n = 15). We measured the serum levels of TNF-α, IL-6 by Enzyme Linked Immunosorbent Assay (ELISA) method. We also calculated dynamic lung compliance (Cdyn) and P[A-a]O₂ before CPB(t1), 0min after the termination of CPB (t2), 2h (t3) and 6h after the CPB (t4) accroding to these datas : pulmonary arterial pressure , Ppause , PEEP ,TV, F, FiO2 . Patients'some clinical indexes (time for aorta clamp, CPB , mechanical ventilation, ICU-staying and days of hospitalization) were monitored. Analysis the effect on TNF-α,IL-6,dynamic lung compliance (Cdyn),P[A-a]O₂ and pulmonary artery pressure afer ultrafiltration .Results The serum levels of TNF-α, IL-6 after CPB were significantly higher than that before CPB(P<0.05). The serum levels of TNF-αand IL-6 gradually increased after the beginning of CPB(Except T1). The serum level of TNF-αreached the peak at 2h after the end of CPB, and that still maintained a high level at 24h after the end of CPB. The serum level of IL-6 reached the peak at 6h after the end of CPB, then began to decrease but still higher than the concentration before CPB significantly. The serum levels of TNF-αand IL-6 in ultrafiltration group were significantly lower than that in control group (P<0.01). TNF-αand IL-6 were detected in the filtrate .CPB produced a significant decrease in dynamic lung compliance and gas exchange capacity in both groups(P<0.05). But there were better dynamic lung compliance and lower P[A-a]O₂ in ultrafiltration group(P<0.05). Two groups of patients with pulmonary artery pressure were decreased, but no statistical significance (p>0.05) , and the hospital days are also no difference (p>0.05).Conclusion The study demonstrated that there were increases of amount of serum proinflammatory cytokines TNF-α, IL-6 during CPB in patients undergoing CPB, which lead to the lung injury , the Cdyn decrease and the P[A-a]O₂ increase. ultrafiltration during CPB could significantly reduce the increasing of IL-6 and TNF-αlevels and shorten the time for mechanical ventilation and ICU, improve dynamic lung compliance (Cdyn) , which demonstrated ultrafiltration have a better lung protection role.