Stefanou D C, Gourlay T, Asimakopoulos G, Taylor K M
Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
Perfusion. 2001 Jan;16(1):51-8. doi: 10.1177/026765910101600108.
Cardiopulmonary bypass (CPB) is associated with the production of inflammatory responses, which can have significant influence on prognosis. We studied the effects of leucocyte-depletion filters on inflammatory parameters and early postoperative prognosis during coronary revascularization. Twenty patients undergoing elective coronary revascularization were randomly divided into two groups. Ten patients had leucocyte-depletion filters added to the CPB circuit (treatment group) and 10 were used as control cases (control group). Expression of CD11b on neutrophils, and production of myeloperoxidase and lactoferrin, were measured in arterial samples between induction and 3 h postbypass. In addition, clinical parameters were measured during inpatient recovery. CD11b neutrophil expression, and myeloperoxidase and lactoferrin production, were found to be upregulated during CPB and then to decline to preoperative levels by the third postoperative hour. Blood transfusion requirements were reduced in the treatment group, equalling 1.5 +/- 1.2 units, compared to 2.7 +/- 1.1 units for the control group (p value = 0.034) and so were the volumes of crystalloid infused during the first 24 h postoperatively, equalling 3.9 +/- 1.21 in the treatment group and 3.3 +/- 0.71 in the control group (p value = 0.021). Overall, the application of leucocyte depletion produced an early clinical advantage, underlining the need for an improved understanding and manipulation of the inflammatory response to CPB.
体外循环（CPB）与炎症反应的产生有关，炎症反应会对预后产生重大影响。我们研究了白细胞滤器对冠状动脉血运重建术中炎症参数及术后早期预后的影响。20例行择期冠状动脉血运重建术的患者被随机分为两组。10例患者在CPB回路中添加白细胞滤器（治疗组），10例作为对照病例（对照组）。在诱导期至体外循环后3小时之间，测量动脉血样本中中性粒细胞上CD11b的表达以及髓过氧化物酶和乳铁蛋白的产生。此外，在住院恢复期间测量临床参数。结果发现，CPB期间CD11b中性粒细胞表达以及髓过氧化物酶和乳铁蛋白的产生上调，然后在术后第3小时降至术前水平。治疗组的输血需求量减少，平均为1.5±1.2单位，而对照组为2.7±1.1单位（p值=0.034），术后24小时内输注的晶体液量也是如此，治疗组为3.9±1.21，对照组为3.3±0.71（p值=0.021）。总体而言，白细胞滤器的应用产生了早期临床优势，强调了需要更好地理解和控制对CPB的炎症反应。
