Baksaas S T, Videm V, Fosse E, Karlsen H, Pedersen T, Mollnes T E, Hagve T A, Svennevig J L
Department of Surgery A, National Hospital, University of Oslo, Norway.
Perfusion. 1999 Jan;14(1):11-9. doi: 10.1177/026765919901400103.
Cardiopulmonary bypass (CPB) exposes blood to large, foreign surfaces. This exposure may activate the cellular and humoral inflammatory systems, resulting in inflammatory reactions and organ dysfunction. Coating the inner surfaces of the bypass circuit may help alleviate these side-effects. The objective of this study was to determine the influence of two new surface treatments on blood cell and complement activation. Oxygenator and tubing sets coated with synthetic polymers (n = 7) or heparin (n = 7) were compared to uncoated sets (n = 7) in an in vitro model of CPB. The circuits were run at 4 l/min and recirculated for 120 min. The inflammatory response was assessed at regular intervals by platelet counts, and activation of complement, leucocytes and platelets. We found that the median platelet counts decreased from 127 to 122 x 10(9)/l (not significant, NS) in the synthetic polymer sets, from 96 to 88 x 10(9)/l (NS) in the heparin-coated sets, and from 93 to 54 x 10(9)/l (p < 0.01) in the uncoated sets after 2 h of recirculation. There were significant differences in platelet counts between the coated sets and the uncoated set at end of experiments (p < 0.05). Beta-thromboglobulin (BTG) concentrations increased in the synthetic polymer sets from 166 to 352 ng/ml (p < 0.01), in the heparin coated sets from 336 to 1168 ng/ml (p < 0.01), and in the uncoated sets from 301 to 3149 ng/ml (p < 0.01) after 2 h of recirculation. The differences in BTG at termination of the experiments were significant among all three sets (p < 0.05). Myeloperoxidase (MPO) concentrations in the synthetic polymer sets increased from 63 to 86 micrograms/l (p < 0.01), in the heparin-coated sets from 90 to 208 micrograms/l (p < 0.01), and in the uncoated sets from 122 to 513 micrograms/l (p < 0.01) after 2 h of recirculation. The differences in MPO at termination of the experiments were significant among all three groups (p < 0.01). There were no significant differences at termination of the experiments among the three sets regarding complement activation as measured by C3 activation products and the terminal complement complex. We conclude that in the current in vitro model of a CPB circuit, the synthetic polymer coating and the heparin coating caused significantly less platelet loss and granulocyte and platelet activation than the uncoated surface (p < 0.05). The synthetic polymer coating caused significantly less granulocyte and platelet activation than the heparin coating (p < 0.05). There was moderate complement activation within each group, but no significant differences among the three groups.
体外循环（CPB）会使血液暴露于大型异物表面。这种暴露可能会激活细胞和体液炎症系统，导致炎症反应和器官功能障碍。在体外循环回路的内表面进行涂层处理可能有助于减轻这些副作用。本研究的目的是确定两种新的表面处理方法对血细胞和补体激活的影响。在CPB体外模型中，将涂有合成聚合物（n = 7）或肝素（n = 7）的氧合器和管路组与未涂层组（n = 7）进行比较。回路以4升/分钟的速度运行，并再循环120分钟。通过血小板计数以及补体、白细胞和血小板的激活情况定期评估炎症反应。我们发现，再循环2小时后，合成聚合物组的血小板计数中位数从127降至122×10⁹/升（无显著差异，NS），肝素涂层组从96降至88×10⁹/升（NS），未涂层组从93降至54×10⁹/升（p < 0.01）。实验结束时，涂层组和未涂层组之间的血小板计数存在显著差异（p < 0.05）。再循环2小时后，合成聚合物组的β-血小板球蛋白（BTG）浓度从166增加至352纳克/毫升（p < 0.01），肝素涂层组从336增加至1168纳克/毫升（p < 0.01），未涂层组从301增加至3149纳克/毫升（p < 0.01）。实验结束时，三组之间BTG的差异具有显著性（p < 0.05）。再循环2小时后，合成聚合物组的髓过氧化物酶（MPO）浓度从63增加至86微克/升（p < 0.01），肝素涂层组从90增加至208微克/升（p < ），未涂层组从122增加至513微克/升（p < 0.01）。实验结束时，三组之间MPO的差异具有显著性（p < 0.01）。通过C3激活产物和末端补体复合物测量补体激活情况，实验结束时三组之间没有显著差异。我们得出结论，在当前CPB回路的体外模型中，与未涂层表面相比，合成聚合物涂层和肝素涂层导致的血小板损失以及粒细胞和血小板激活明显更少（p < 0.05）。合成聚合物涂层导致的粒细胞和血小板激活明显少于肝素涂层（p < 0.05）。每组中均有适度的补体激活，但三组之间没有显著差异。 0.01），肝素涂层组从90增加至208微克/升（p < 0.01），未涂层组从122增加至513微克/升（p < 0.01）。实验结束时，三组之间MPO的差异具有显著性（p < 0.01）。通过C3激活产物和末端补体复合物测量补体激活情况，实验结束时三组之间没有显著差异。我们得出结论，在当前CPB回路的体外模型中，与未涂层表面相比，合成聚合物涂层和肝素涂层导致的血小板损失以及粒细胞和血小板激活明显更少（p < 0.05）。合成聚合物涂层导致的粒细胞和血小板激活明显少于肝素涂层（p < 0.05）。每组中均有适度的补体激活，但三组之间没有显著差异。
