Asimakopoulos G
Cardiothoracic Department, Imperial College School of Medicine at Hammersmith Hospital, London, UK.
Perfusion. 2001 Sep;16(5):353-60. doi: 10.1177/026765910101600505.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with the development of a systemic inflammatory response that can often lead to dysfunction of major organs. The systemic inflammation can be assessed intra- and postoperatively by measuring concentrations of inflammatory mediators in plasma and tissues. These concentrations, however, do not always correlate with the degree of observed organ dysfunction. Various strategies have been used to reduce inflammatory phenomena in patients undergoing CPB. Cardiac surgery without CPB has been performed increasingly with satisfactory results over the past few years. Attenuation of systemic inflammation and improved outcome in high risk patients are potential benefits of this technique. The emergence and expanding performance of cardiac surgical procedures without the use of CPB has given us an excellent tool to investigate the relative importance of CPB as a cause of systemic inflammation. Aprotinin is a protease inhibitor which is used in cardiac surgical patients for its haemostatic effects. Aprotinin has anti-inflammatory properties, the nature of which have not been completely clarified. This article presents a summary of the published literature investigating inflammatory response and organ dysfunction in patients who have cardiac surgery without CPB. It also presents an overview of recent data on the anti-inflammatory action mechanisms of aprotinin.
体外循环（CPB）心脏手术会引发全身炎症反应，常导致主要器官功能障碍。全身炎症可在术中及术后通过测量血浆和组织中炎症介质的浓度来评估。然而，这些浓度并不总是与观察到的器官功能障碍程度相关。已采用多种策略来减少接受CPB患者的炎症现象。在过去几年中，非体外循环心脏手术的开展越来越多，效果令人满意。减轻全身炎症以及改善高危患者的预后是该技术的潜在益处。不使用CPB的心脏手术的出现及应用范围的扩大，为我们研究CPB作为全身炎症原因的相对重要性提供了一个极好的工具。抑肽酶是一种蛋白酶抑制剂，因其止血作用而用于心脏手术患者。抑肽酶具有抗炎特性，但其性质尚未完全阐明。本文总结了已发表的关于非体外循环心脏手术患者炎症反应和器官功能障碍的文献。还概述了关于抑肽酶抗炎作用机制的最新数据。
