改良超滤对体外循环婴儿血浆血栓素B2、白三烯B4和内皮素-1的影响。

Effect of modified ultrafiltration on plasma thromboxane B2, leukotriene B4, and endothelin-1 in infants undergoing cardiopulmonary bypass.

作者信息

Pearl J M, Manning P B, McNamara J L, Saucier M M, Thomas D W

机构信息

Division of Pediatric Cardiothoracic Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.

出版信息

Ann Thorac Surg. 1999 Oct;68(4):1369-75. doi: 10.1016/s0003-4975(99)00978-9.

DOI:10.1016/s0003-4975(99)00978-9

PMID:10543508

Abstract

BACKGROUND

Plasma thromboxane B2 (TXB2), leukotriene B4 (LTB4), and endothelin-1 (ET-1) levels increase on cardiopulmonary bypass (CPB). Elevated levels of TXB2 and ET-1 have been correlated with postoperative pulmonary hypertension in infants undergoing repair of congenital heart defects. LTB4 is a potent chemotactic cytokine whose levels correlate with leukocyte-mediated injury. Modified ultrafiltration (MUF) has been associated with improved hemodynamics and pulmonary function, in addition to its beneficial effects on fluid balance and blood conservation. Recent investigations have suggested that removal of cytokines may be the cause of the improved cardiopulmonary function seen with MUF.

METHODS

Plasma TXB2, ET-1, and LTB4 levels were measured in 34 infants undergoing CPB: 22 underwent MUF (group 1), and 12 did not (group 2). Samples were obtained at various time points. All patients underwent conventional ultrafiltration during the rewarming phase of cardiopulmonary bypass.

RESULTS

In group 1, mean end-CPB TXB2 level was 101.2 pg/mL versus 46.9 pg/mL post-MUF (p < 0.05). The mean TXB2 level 1 hour post-CPB (54.1 pg/mL) was not significantly different from the post-MUF level. In group 2, the mean end-CPB TXB2 level was 123.6 pg/mL versus 53.2 pg/mL 1 hour post-CPB. Hence, TXB2 levels decreased by similar amounts and to similar levels by 1 hour post-CPB in both groups. ET-1 levels increased after CPB and were unaffected by MUF: 1.45, 1.80, 2.55 pg/mL at end-CPB, post-MUF, and 1 hour post-CPB, respectively, in group 1; and 1.51, and 2.73 pg/mL at end-CPB and 1 hour post-CPB in group 2. LTB4 levels post-MUF were 119% of pre-MUF values, and were similar at 1 hour post-CPB in both groups.

CONCLUSIONS

Despite reduction in TXB2 by MUF, values were similar and approached baseline 1 hour post-CPB in both groups. LTB4 levels increased slightly with MUF. ET-1 levels increased during and post-CPB and were unaffected by MUF. MUF does not appear to have a significant effect on post-CPB levels of TXB2, ET-1, and LTB4. Therefore, the improved hemodynamics observed with MUF do not appear to be related to removal of these cytokines.

摘要

背景

在体外循环（CPB）期间，血浆血栓素B2（TXB2）、白三烯B4（LTB4）和内皮素-1（ET-1）水平会升高。TXB2和ET-1水平升高与先天性心脏病修复术后婴儿的肺动脉高压相关。LTB4是一种强效趋化细胞因子，其水平与白细胞介导的损伤相关。改良超滤（MUF）除了对液体平衡和血液保护有有益作用外，还与改善血流动力学和肺功能有关。最近的研究表明，细胞因子的清除可能是MUF改善心肺功能的原因。

方法

对34例接受CPB的婴儿测定血浆TXB2、ET-1和LTB4水平：22例接受MUF（第1组），12例未接受MUF（第2组）。在不同时间点采集样本。所有患者在体外循环复温阶段均接受常规超滤。

结果

在第1组中，CPB结束时TXB2平均水平为101.2 pg/mL，而MUF后为46.9 pg/mL（p<0.05）。CPB后1小时TXB2平均水平（54.1 pg/mL）与MUF后水平无显著差异。在第2组中，CPB结束时TXB2平均水平为123.6 pg/mL，而CPB后1小时为53.2 pg/mL。因此，两组在CPB后1小时TXB2水平下降幅度相似且降至相似水平。ET-1水平在CPB后升高且不受MUF影响：第1组在CPB结束时、MUF后和CPB后1小时分别为1.45、1.80、2.55 pg/mL；第2组在CPB结束时和CPB后1小时分别为1.51和2.73 pg/mL。MUF后LTB4水平为MUF前值的119%，两组在CPB后1小时相似。