Gourlay T
Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College School of Medicine at Hammersmith, Hammersmith Hospital, London, UK.
Perfusion. 2001 Sep;16(5):381-90. doi: 10.1177/026765910101600508.
Cardiopulmonary bypass (CPB) is dependent on materials foreign to the patient for its successful application. When blood comes into contact with these so-called biomaterials, an inappropriate inflammatory response, which can be life-threatening in some patients, may develop. The reason for this inappropriate activation of host defence mechanisms is not entirely clear, however a number of strategies have evolved over the years to minimize this unwanted sequelae of CPB. These strategies include surface coating of the materials of the circuit, using new materials thought to improve biocompatibility, and using a number of pharmacological interventions designed to suppress the inflammatory response. Recently, there has been some evidence which indicates that the plasticizer employed in the polyvinyl chloride (PVC) tubing of the CPB circuit may play a part in the development of the inflammatory response. The work described in this paper tends to support this thesis. These studies showed that by washing the plasticizer from the surface of the PVC tubing, the biocompatibility, as reflected in the upregulation of CD11b on the surface of neutrophils, was enhanced. Furthermore, the use of non-plasticized substitutes for PVC had a similar effect. The benefit from removing the plasticizer was similar to that gained from surface coating with heparin, one of the conventional approaches to reducing the inflammatory response to CPB.
体外循环（CPB）的成功应用依赖于患者体外的材料。当血液与这些所谓的生物材料接触时，可能会引发不适当的炎症反应，在某些患者中这种反应可能危及生命。宿主防御机制这种不适当激活的原因尚不完全清楚，不过多年来已发展出多种策略来尽量减少CPB这种不良后遗症。这些策略包括对体外循环回路材料进行表面涂层处理、使用被认为能改善生物相容性的新材料，以及采用一些旨在抑制炎症反应的药物干预措施。最近，有证据表明CPB回路的聚氯乙烯（PVC）管道中使用的增塑剂可能在炎症反应的发生中起作用。本文所述的研究倾向于支持这一论点。这些研究表明，通过从PVC管道表面洗去增塑剂，以中性粒细胞表面CD11b上调所反映的生物相容性得到了增强。此外，使用不含增塑剂的PVC替代品也有类似效果。去除增塑剂带来的益处与用肝素进行表面涂层处理（这是减少对CPB炎症反应的传统方法之一）所获得的益处相似。
