The effect of cardiopulmonary bypass on monocyte HLA-DR expression
- VernacularTitle:体外循环对单核细胞HLA-DR表达的影响
- Author:
Xiangming FANG
;
Yan QIU
;
Jing XU
- Publication Type:Journal Article
- Keywords:
Cardiopulmonary bypass;
Monocytes;
HLA DR antigens
- From:
Chinese Journal of Anesthesiology
1996;0(07):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective The purpose of this study was to investigate the effects of cardiopulmonary bypass(CPB) on monocyte HLA DR expression and immune function Methods Sixteen ASA Ⅱ Ⅳ patients [mean age (38 5?5 1)yr,mean body weight (42 9?10 2kg)] of both sexes (male 7,female 9) with rheumatic value disease undergoing mitral value replacement (11 patients) and mitral value and aortic value replacement (5 patients) with moderate hypothermic CPB were enrolled in this study Another ten patients undergoing lung lobectomy were used as control group Patients suffering from infection, immuno deficiency or receiving corticosteroid or immunoregulatory drugs were excluded Premedication included intramusallar midazolam 0 1mg?kg -1 and morphine 0 1mg?kg -1 Anesthesia was induced with intravenous midazolam 0 15mg?kg -1 , fentanyl 8?g/kg and vecuronium 0 1mg?kg -1 and maintained with isoflurane inhalation (0 8%～1 2%) and intermittent boluses of fentanyl and vecuronium The total dose of fentanyl was (18 3?3 2)?g/kg in CPB group and (9 6?1 3)?g/kg in control group CPB time was (74 2?22 5) min and aortic clamping time (57 5?19 2) min Blood samples were taken from CVP line before and 5 min after induction of anesthesia, before and after CPB and on the 1st, 3rd and 5th postoperative day for determination monocyte count and percentage of HLA DR + monocytes Results The number of monocytes decreased at the end of surgery but greatly increased on the postoperative days The percentage of HLA DR + monocytes also decreased at the end of surgery and decreased further on the 1st postoperative day but started increasing on the 3rd postoperative day In two patients who developed infection the percentage of HLA DR + monoeytes was lower than the average percentage of HLA DR + monocytes of the other 14 CPB patients In control group the percentage of HLA DR + monocytes also decreased significantly after operation but there was no significant change in the number of monocytes However there was a significant difference in monoeyte HLA DR expression between the two groups Conclusions The changes in monocyte HLA DR expression and monocyte count may be induced by impaired immune response after CPB and dynamic monitoring of monocyte HLA DR expression may help to predict complication of infection after CPB
