Honore P M, Jacquet L M, Beale R J, Renauld J C, Valadi D, Noirhomme P, Goenen M
Cardiothoracic Intensive Care Unit, St-Luc Teaching Hospital, Brussels, Belgium.
Crit Care Med. 2001 Oct;29(10):1903-9. doi: 10.1097/00003246-200110000-00009.
To evaluate the influence of perfusion temperature on the systemic effects of cardiopulmonary bypass (CPB), including extravascular lung water index (EVLWI), and serum cytokines.
Prospective, randomized, controlled study.
Cardiothoracic intensive care unit of a university hospital.
Patients undergoing elective coronary artery bypass grafting.
Twenty-one patients undergoing elective coronary artery bypass grafting were randomly assigned to receive either normothermic bypass (36 degrees C, n = 8) with intermittent antegrade warm blood cardioplegia (IAWBC), or hypothermic (32 degrees C, n = 13) CPB with cold crystalloid cardioplegia.
Mean arterial pressure, heart rate, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure, and pulmonary vascular resistance were determined at baseline, i.e., after induction of anesthesia but before sternal opening (T-1), at arrival in the intensive care unit (T0), and 4 hrs (T4), 8 hrs (T8), and 24 hrs (T24) after surgery. EVLWI, intrathoracic blood volume index (ITBVI), and EVLW/ITBV ratio were obtained by using thermal dye dilution utilizing an arterial thermistor-tipped fiberoptic catheter and were recorded at T-1, T0, T4, T8, and T24. Serial blood samples for cytokine measurements were obtained at each hemodynamic measurement time point. Before, during, and after CPB, there were no differences in the conventional hemodynamic measurements between the groups. There were no changes in EVLWI up to T8 in either group. Furthermore, no change in the ratio EVLW/ITBW was observed between the groups at any time, further indicating the absence of a change in pulmonary permeability. Plasma levels of interleukin-6, tumor necrosis factor-alpha, and interleukin-10 increased during and after CPB, independently of the perfusion temperature.
Normothermic CPB is not associated with additional inflammatory and related systemic adverse effects regarding cytokine production and EVLWI as compared with mild hypothermia. The potential temperature-dependent release of cytokines and subsequent inflammation has not been observed and normothermic CPB may be seen as a safe technique regarding this issue.
评估灌注温度对体外循环（CPB）全身影响的作用，包括血管外肺水指数（EVLWI）和血清细胞因子。
前瞻性、随机、对照研究。
大学医院心胸重症监护病房。
接受择期冠状动脉旁路移植术的患者。
21例接受择期冠状动脉旁路移植术的患者被随机分配，分别接受常温体外循环（36摄氏度，n = 8）加间歇性顺行温血心脏停搏液（IAWBC），或低温（32摄氏度，n = 13）CPB加冷晶体心脏停搏液。
在基线时、即麻醉诱导后但胸骨切开前（T-1）、进入重症监护病房时（T0）以及术后4小时（T4）、8小时（T8）和24小时（T24）测定平均动脉压、心率、心输出量、全身血管阻力、平均肺动脉压和肺血管阻力。使用带有动脉热敏电阻尖端的光纤导管通过热染料稀释法获得EVLWI、胸腔内血容量指数（ITBVI）和EVLW/ITBV比值，并在T-1、T0、T4、T8和T24记录。在每个血流动力学测量时间点采集系列血样用于细胞因子检测。在CPB前、期间和之后，两组之间的传统血流动力学测量无差异。两组在T8之前EVLWI均无变化。此外，两组在任何时候EVLW/ITBW比值均未观察到变化，进一步表明肺通透性无变化。CPB期间及之后，血浆白细胞介素-6、肿瘤坏死因子-α和白细胞介素-10水平升高，与灌注温度无关。
与轻度低温相比，常温CPB在细胞因子产生和EVLWI方面不会引发额外的炎症及相关全身不良反应。未观察到细胞因子潜在的温度依赖性释放及随后的炎症反应，就此问题而言，常温CPB可被视为一种安全技术。
