Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Efficacies of the Modified Ultrafiltration and Peritoneal Dialysis in Removing Inflammatory Mediators After Pediatric Cardiac Surgery

소아 개심술 후 변형 초여과법과 복막투석의 염증 매개체 (inflammatory mediator)의 감소에 대한 효과

  • 성시찬 (동아대학교 의과대학 흉부외과학 교실) ;
  • 정민호 (동아대학교 의과대학 미생물학 교실)
  • Published : 2001.10.01
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Abstract

capillary leak syndrome and organ dysfunction in infants. Removing harmful cytokines and complement anaphylatoxins after cardiopulmonary bypass may attenuate this response. This study was conducted to see if the modified ultrafiltration and postoperative peritoneal dialysis can reduce plasma inflammatory mediators in pediatric cardiac surgery. Material and Method: 30 infants (age 1.1 to 12.6 months) who underwent closures of ventricular septal defect using cardiopulmonary bypass (CPB) were enrolled in this study. These patients were divided into three groups; 10 patients selected randomly underwent modified ultrafiltration (Group U), 10 with small body weights ($\leq$5 kg) received postoperative peritoneal dialysis (Group P), and 10 patients did not undergo modified ultrafiltration nor receivcd peritoneal dialysis (Group C). Serum samples were obtained before and after CPB, and after peritoneal dialysis. Effluents sample were also obtained after modified ultrafiltration or peritoneal dialysis. C3a and interleukin-6 (IL-6) were measured by radioimmunoassay and enzyme-linked immunosorbent assay respectively. Result: There was no differences in CPB time, aortic cross-clamping title, and lowest temperature during CPB. The effluents of peritoneal dialysis contained significant amount of C3a and IL-6, but there was no definitive decrease of serum concentration of C3a and IL-6. The effluents of modified ultrafiltration had some amount of C3a and negligible IL-6, and there was no decrease of serum concentration of these (actors. Conclusion: The effluents of peritoneal dialysis contained significant amount of proinflammatory cytokine, IL-6 and complement, C3a. However this study failed to elucidate the decrease in serum levels of these factors. The modified ultrafiltration also was not able to reduce the serum levels of C3a or IL-6 in our study as well.

배경: 체외순환은 보체의 활성화와 cytokine의 유리에 의한 급성 전신성 염증반응을 일으킨다. 이 반응은 소아들에 있어 모세혈관 누출 증후군이나 여러 장기의 기능장애를 일으킬 수 있다. 유해한 cytokine들이나 보체anaphylatoxin들을 제거함으로서 이들에 의한 염증반응을 완화시킬 수 있을 것이다. 개심술 후 변형 초여과법과 복막투석이 소아 개심술 후 혈중 염증 매개체를 감소시킬 수 있는가를 알아보기 위해 이 연구를 시행하였다. 대상 및 방법: 모두 30떵의 심실중격결손증 환아(생후 1.1∼12.6개월)들을 대상으로 하여 이들을 10명씩 세 군으로 나누어 연구하였다. 10명은 변형 초여과법을 시행한 군(U군), 다른 10명은 체중이 작은 소아(5kg 이하)들로서 술 후 복막투석을 한 군(P군), 나머지 10명은 변형 초여과법이나 복막투석을 시행하지 않은 대조군(C군)으고 나누었다. 체외순환 전후, 복막투석 후 혈청 샘플을 채취하였으며 변형 초여과의 여과액과 복막투석 배액을 채취하여 C3a와 인터루킨-6(IL-6)를 각각 radioimmunoassay법과 enzyme-linked immunosorbent assay법으로 측정하였다. 결과: 각 군간에 체외순환 시간, 대동맥차단 시간, 저체온의 정도 등은 차이가 없었다. 복막투석 배액에는 상당한 농노의 C3a와 IL-6를 포함하고 있었으나 혈청 C3a, IL-6 농도의 저하는 없었다. 변형 초여과의 여과액에는 낮은 농도의 C3a가 검출되었고 혈청 C3a 농도에도 영향을 주지 못하였으며 IL-67는 검출되지 않았다. 결론: 복막투석 배액에는 높은 농도의 C3a와 IL-6를 포함하고 있었지만 이들의 혈청 농도를 감소시키는데는 효과가 없었으며 변형 초여과법 역시 혈청 C3a와 IL-6의 감소 효과는 없었다.

Keywords

References

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