Di Salvo C, Louca L L, Pattichis K, Hooper J, Walesby R K
Royal Hospitals, Department of Cardiac Surgery, London, UK.
J Cardiovasc Surg (Torino). 1996 Dec;37(6 Suppl 1):93-100.
An important factor in the production of myocardial damage following cardiopulmonary bypass in the creation of oxygen derived free radicals. Few sources for these radicals have been identified but experimentally activated neutrophils are known to release free radical which contribute to myocyte necrosis. The aim of this pilot study was to identify whether, by depleting patients of leukocytes and particularly neutrophils on bypass, a better degree of myocardial protection could be observed using specific identifiers of myocardial damage. Ten patients undergoing urgent coronary artery bypass for unstable angina with impaired left ventricular function were leuko-depleted using a PALL medical leukocyte filter in the extra corporeal circulation together with leukocyte depletion of all transfused blood. A similar group of matched controls had only an arterial line filter without leukodepletion. All patients were operated by one surgeon using identical techniques of intermittent cross clamping and fibrillation at moderate hypothermia. Full blood count, Glutathione, Troponin T and CPK/MB were measured before, during and at identified intervals up to 72 hour after bypass. Preliminary results show little change in the total leukocyte count but the Troponin T and CPK/MB values were lower in the filtered group than in the control group and an increased level of total Glutathione in the filter group showed that there was less oxidated stress on the myocardium. Currently this filter is an expensive addition to bypass surgery but these preliminary results suggest that activated neutrophil depletion on bypass may be of benefit to patients with unstable angina, impending myocardial necrosis and low ejection fraction.
体外循环后产生心肌损伤的一个重要因素是氧衍生自由基的生成。目前已确定的这些自由基来源很少，但实验表明，被激活的中性粒细胞会释放自由基，进而导致心肌细胞坏死。本初步研究的目的是，通过在体外循环期间清除患者的白细胞，尤其是中性粒细胞，利用心肌损伤的特定指标，观察是否能实现更好的心肌保护效果。10例因不稳定型心绞痛伴左心室功能受损而接受紧急冠状动脉搭桥手术的患者，在体外循环中使用颇尔医疗白细胞滤器进行白细胞清除，同时对所有输注的血液也进行白细胞清除。一组匹配的对照组患者仅使用动脉管路滤器，未进行白细胞清除。所有患者均由同一位外科医生采用相同技术，在中度低温下进行间歇性交叉夹闭和心脏颤动。在体外循环前、期间以及体外循环后72小时内的特定时间间隔测量全血细胞计数、谷胱甘肽、肌钙蛋白T和肌酸磷酸激酶同工酶（CPK/MB）。初步结果显示，两组患者的白细胞总数变化不大，但滤器组的肌钙蛋白T和CPK/MB值低于对照组，滤器组的总谷胱甘肽水平升高表明心肌的氧化应激较小。目前，这种滤器在体外循环手术中是一项昂贵的附加装置，但这些初步结果表明，在体外循环期间清除被激活的中性粒细胞可能对不稳定型心绞痛、即将发生心肌坏死且射血分数较低的患者有益。
