Grünenfelder J, Zünd G, Schoeberlein A, Schmid E R, Schurr U, Frisullo R, Maly F, Turina M
Clinic of Cardiovascular Surgery, University Hospital, Rämistrasse 100, 8091, Zürich, Switzerland.
Eur J Cardiothorac Surg. 2000 Jun;17(6):723-8. doi: 10.1016/s1010-7940(00)00401-2.
Cardiac surgery with cardiopulmonary bypass (CPB) results in vascular injury and tissue damage which involves leukocyte-endothelial interactions mediated by cytokines and adhesion molecules. This study was designed to demonstrate the effect of normothermic and hypothermic CPB to cytokine and soluble adhesion molecule levels in adults and to determine whether these levels correlate to the patients postoperative course.
In 25 patients after normothermic and in 25 patients after hypothermic coronary artery bypass grafting with cardiopulmonary bypass (CPB), blood samples for cytokine and soluble adhesion molecule analysis were taken preoperatively, 24, 36, 48 h, and 6 days postoperatively. Soluble adhesion molecules (sE-selectin, sICAM-1) were measured by ELISA and cytokines (TNF-alpha, IL-6, IL-8) by chemilumenscent-immunoassay. Clinical data were collected prospectively.
Postoperatively, adhesion molecule and cytokine levels were significantly elevated after CPB. Mean plasma levels of sICAM-1 was 2.4-fold higher after 6 days. Mean plasma concentration of sE-selectin peaked after 48 h with a 2-fold increase compared to normothermic conditions. In the hypothermia group sICAM-1, sE-selectin, IL-6, and IL-8 showed significantly higher levels (P<0.0057, P<0.0012, P<0.0419, P<0.0145) after 24 h compared to the normothermia group. No clinical differences were seen.
Adhesion molecules and cytokines are elevated after CPB. Patients after hypothermic CPB show significant higher sICAM-1, sE-selectin, IL-6, and IL-8 levels after 24 h compared to normothermic conditions. These results are mainly due to longer CPB and crossclamp times but do not alter the patient's postoperative course.
体外循环（CPB）心脏手术会导致血管损伤和组织损伤，这涉及由细胞因子和黏附分子介导的白细胞-内皮细胞相互作用。本研究旨在证明常温与低温CPB对成人细胞因子和可溶性黏附分子水平的影响，并确定这些水平是否与患者术后病程相关。
选取25例行常温体外循环冠状动脉搭桥术的患者以及25例行低温体外循环冠状动脉搭桥术的患者，于术前、术后24小时、36小时、48小时及6天采集血样进行细胞因子和可溶性黏附分子分析。采用酶联免疫吸附测定法（ELISA）检测可溶性黏附分子（sE-选择素、sICAM-1），采用化学发光免疫测定法检测细胞因子（TNF-α、IL-6、IL-8）。前瞻性收集临床数据。
术后，CPB后黏附分子和细胞因子水平显著升高。术后6天，sICAM-1的平均血浆水平高出2.4倍。sE-选择素的平均血浆浓度在48小时达到峰值，与常温情况相比升高了2倍。与常温组相比，低温组术后24小时sICAM-1、sE-选择素、IL-6和IL-8水平显著更高（P<0.0057，P<0.0012，P<0.0419，P<0.0145）。未观察到临床差异。
CPB后黏附分子和细胞因子水平升高。与常温CPB相比，低温CPB患者术后24小时sICAM-1、sE-选择素、IL-6和IL-8水平显著更高。这些结果主要归因于CPB和主动脉阻断时间更长，但并未改变患者的术后病程。
