Iwasaka H, Kitano T, Miyakawa H, Unoshima M, Shinguu C, Matsumoto S, Noguchi T
Department of Anaesthesiology, Oita Medical University, Japan.
Can J Anaesth. 2001 Jan;48(1):81-4. doi: 10.1007/BF03019820.
The precise mechanism of neutrophilia after cardiac surgery is unknown. Granulocyte colony stimulating factor (G-CSF) can increase the number of leukocytes. The purpose of this study was to evaluate the relationship between serum G-CSF levels and peripheral blood leukocyte counts after cardiac surgery.
We prospectively studied 10 patients undergoing cardiac surgery (coronary artery bypass grafting) using cardiopulmonary bypass (CPB). Plasma G-CSF levels and neutrophil count were measured before induction of anaesthesia, at the end of surgery, and on the first postoperative day. These changes were compared with those in patients undergoing non-cardiac major surgery (control group).
At the end of surgery, G-CSF levels increased (P < 0.01) in both groups, but were higher in the control than in the cardiac group (3,250 +/- 690 vs 194 +/- 29.5 pg ml(-1), respectively, mean +/- SEM, P < 0.01). On the first postoperative day, G-CSF levels were still high in both groups, and were still higher in the control (710 +/- 179 vs 122 +/- 19.9, respectively, P < 0.01). However, neutrophilia was greater in the cardiac group than in the control. G-CSF response correlated positively with neutrophilia in the control group (r = 0.656, P < 0.05) but not in the cardiac group.
Our results indicate that changes in leukocyte count following cardiac surgery are unique to patients undergoing CPB. G-CSF plays an important role as the mediator of neutrophilia after non-cardiac surgery, but not after cardiac surgery with CPB.
心脏手术后中性粒细胞增多的确切机制尚不清楚。粒细胞集落刺激因子（G-CSF）可增加白细胞数量。本研究旨在评估心脏手术后血清G-CSF水平与外周血白细胞计数之间的关系。
我们前瞻性地研究了10例接受体外循环（CPB）心脏手术（冠状动脉旁路移植术）的患者。在麻醉诱导前、手术结束时和术后第一天测量血浆G-CSF水平和中性粒细胞计数。将这些变化与接受非心脏大手术的患者（对照组）进行比较。
手术结束时，两组G-CSF水平均升高（P<0.01），但对照组高于心脏手术组（分别为3250±690与194±29.5 pg/ml，均值±标准误，P<0.01）。术后第一天，两组G-CSF水平仍然很高，且对照组仍然更高（分别为710±179与122±19.9，P<0.01）。然而，心脏手术组的中性粒细胞增多比对照组更明显。对照组中G-CSF反应与中性粒细胞增多呈正相关（r=0.656，P<0.05），但在心脏手术组中无相关性。
我们的结果表明，心脏手术后白细胞计数的变化是接受CPB患者所特有的。G-CSF在非心脏手术后作为中性粒细胞增多的介质起重要作用，但在CPB心脏手术后并非如此。
