添加一氧化氮的模拟体外循环期间的炎症反应。

Borowiec J W, Lahtinen M, Venge P, Henze A, Stiernström H

Department of Cardiothoracic Surgery, Uppsala University Hospital, Sweden.

J Cardiovasc Surg (Torino). 2000 Apr;41(2):207-13.

BACKGROUND

Heart operations performed with extracorporeal circulation (ECC) are associated with an inflammatory response. This response is partially due to granulocyte activation. Leukocyte derived free radicals are involved in tissue injury. The purpose of this study was to observe whether nitric oxide influence the inflammatory response during simulated ECC.

METHODS

In a model of simulated extracorporeal circulation, fresh whole human blood mixed with Ringer's solution was circulated through a heart-lung machine for three hours. In five circuits NO was added to oxygen/air mixture (group N), while five other circuits were ventilated with oxygen/air mixture (group C). The methods for estimating the inflammatory response were determination of oxygen free radicals production capacity, using chemiluminescence, and measurements of concentration of granulocyte derived proteins (myeloperoxidase and human neutrophil lipocalin).

RESULTS

All measured parameters were similarly independent of additional supply of nitric oxide almost throughout extracorporeal circulation time. The sole significant difference between the two groups was found at an early stage of extracorporeal circulation, when luminol-enhanced chemiluminescence in whole blood was higher in the N group (1,500, 1,470-1,950 vs 1,038, 750-1,050 in the control group; medians with quartiles). A similar tendency was observed in lucigenin-enhanced chemiluminescence at 60 min of extracorporeal circulation (625, 560-875 in the N group vs 400, 360-525 in the control group; medians with quartiles).

CONCLUSIONS

Nitric oxide supply does not influence inflammatory response during three hours long extracorporeal circulation, although some protective effect on hydrogen peroxide production in whole blood was detected in the initial phase of extracorporeal circulation.

背景

体外循环（ECC）下进行的心脏手术会引发炎症反应。这种反应部分归因于粒细胞的激活。白细胞衍生的自由基参与组织损伤。本研究的目的是观察一氧化氮是否会影响模拟体外循环期间的炎症反应。

方法

在模拟体外循环模型中，将新鲜的全血与林格氏液混合，通过心肺机循环三小时。在五个回路中，向氧气/空气混合物中添加一氧化氮（N组），而另外五个回路用氧气/空气混合物通气（C组）。评估炎症反应的方法是使用化学发光法测定氧自由基产生能力，并测量粒细胞衍生蛋白（髓过氧化物酶和人中性粒细胞脂质运载蛋白）的浓度。

结果

几乎在整个体外循环时间内，所有测量参数同样不受一氧化氮额外供应的影响。两组之间唯一显著的差异出现在体外循环的早期阶段，此时N组全血中鲁米诺增强的化学发光更高（1500，1470 - 1950 vs对照组的1038，750 - 1050；中位数及四分位数）。在体外循环60分钟时，光泽精增强的化学发光也观察到类似趋势（N组为625，560 - 875 vs对照组为400，360 - 525；中位数及四分位数）。