[Changes of cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass and the effect of intervention].

ABSTRACT

OBJECTIVE: To investigate the changes of the cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass, and to observe the effect of intervention with ulinastatin. METHODS: Twenty-two ASA II-III patients (9 males, 13 females), aged 20-60 years, undergoing cardiac operation with CPB were randomly divided into 2 groups the control group (Group C, n=11) and the ulinastatin group (Group W, n=11). In Group W, patient received ulinastatin 1.2 x 10(4) U/kg, and half of the dose was given intravenously after the induction of anesthesia, while the same amount of ulinastatin added into the primary solution. And in Group C, normal saline was given instead of ulinastatin. Blood samples were taken from radial artery before the operation (T1), 20 min after the initiation of CPB (T2), 1 h (T3), 6 h (T4 ), 24 h (T5) after the CPB for the determination of plasma TNF-alpha, IL-6, sICAM-1 and sP-Selectin concentrations. RESULTS: The concentrations of TNF-alpha, IL-6 increased significantly at T2-T4 in both groups compared with T1 (P < 0.05), and returned to the baseline level at Ts in Group W. The concentrations of TNF-alpha, IL-6 in Group C at T2-T5 were higher than that in Group W (P < 0.01). The concentrations of sICAM-1, sP-Selectin increased significantly at T3, T4 in both groups compared with that at T1 (P < 0.05). But at T5, the concentrations of sICAM-1, sP-Selectin decreased, especially in Group W the concentrations of sICAM-1, sP-Selectin returned to the baseline level. The sI-CAM-1, sP-Selectin concentrations in group C at T4, T5 were higher than that in group W (P < 0.05). CONCLUSION: Ulinastatin can reduce the increase of the cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass and effectively weaken the inflammatory response to CPB.