Abrahamov D, Erez E, Tamariz M, Dagan O, Pearl E, Abrahamov Y, Gendel B, Desai N, Kats J, Vidne B, Barak V
Department of Cardiothoracic Surgery, Rabin Medical Center, Tel-Aviv University, Petah-Tikva, Israel.
Pediatr Surg Int. 2002 Jan;18(1):54-9. doi: 10.1007/s003830200012.
Capillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly more prominent in the neonatal patients. Low plasma VEFG levels (>35 pg/ml) were found in 3 neonatal control patients and all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4 +/- 559.1 pg/ml, P = 0.02), which decreased during the operation to levels below 35 pg/ml and increased again 24 h postoperatively to levels significantly higher than in the older patients (484 +/- 270.3 pg/ml, P = 0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented by CSTWI (P < 0.01, r = 0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS.
毛细血管渗漏综合征（CLS）以血管外液体积聚和严重器官功能障碍为特征，是接受体外循环（CPB）的儿童的一种严重并发症。我们研究了血浆血管内皮生长因子（VEGF）水平与CLS严重程度之间的关系。研究了11例新生儿和7例接受CPB的大龄儿童血浆中VEGF的动力学，将血浆VEGF水平与CLS临床表现相关联。通过测量细胞外液体积和终末器官功能障碍的参数来量化术后CLS的程度。设计了胸壁软组织宽度指数（CSTWI）以标准化细胞外液积聚。大多数CLS参数在新生儿患者中明显更突出。在3例新生儿对照患者以及除老年组患者样本外的所有样本中发现血浆VEFG水平较低（>35 pg/ml）。新生儿术前VEGF血浆水平显著更高（684.4±559.1 pg/ml，P = 0.02），在手术期间降至35 pg/ml以下，并在术后24小时再次升高至显著高于大龄患者的水平（484±270.3 pg/ml，P = 0.001）。多线性回归分析发现术前VEGF水平与以CSTWI表示的CLS独立相关（P < 0.01，r = 0.726）。因此，新生儿CPB后CLS的发生率以及术前和术后血浆VEGF水平均高于儿童。血浆VEGF水平是术后CLS严重程度的预测指标。
