Tassani P, Schad H, Winkler C, Bernhard A, Ettner U, Braun S L, Eising G P, Kochs E, Lange R, Richter J A
Department of Anesthesiology, Deutsches Herzzentrum München, Germany.
J Thorac Cardiovasc Surg. 2002 Apr;123(4):735-41. doi: 10.1067/mtc.2002.120348.
Operations coupled with cardiopulmonary bypass may provoke a systemic inflammatory response, and it has been suggested that this responses causes capillary leakage of proteins, edema formation, and even organ failure. However, capillary leak syndrome is mainly a clinical diagnosis and has not been verified as yet by actual demonstration of protein leakage from the circulation. We have therefore measured the disappearance of labeled plasma protein before and after cardiopulmonary bypass.
Sixteen patients scheduled for elective coronary artery bypass grafting were enrolled in a prospective controlled study. The cardiopulmonary bypass circuit was primed with crystalloids only. Tumor necrosis factor alpha, interleukin 6, interleukin 8, anaphylatoxin C3a, and terminal complement complex C5b9 levels were determined before, during, and 3 hours after cardiopulmonary bypass. The transvascular escape rate of plasma protein from the intravascular compartment was assessed by measuring the disappearance of intravenously injected Evans blue dye before and during the third hour after cardiopulmonary bypass.
A significant inflammatory response could be demonstrated by means of the 5 measured mediators after bypass. The maximal increase, as compared with the baseline value, was found for interleukin 6 (36-fold). The transvascular escape rate of Evans blue dye was similar before and after bypass (7.6 +/- 0.6%/h vs 7.3 +/- 0.6%/h).
The above data confirm the systemic inflammatory response induced by cardiopulmonary bypass. Contrary to expectations, the transvascular escape rate of Evans blue dye did not change when comparing values before and after bypass. The data do not support the concept of increased protein leakage in the exchange vessels after bypass. We were unable to demonstrate a capillary leak syndrome.
与体外循环相结合的手术可能引发全身炎症反应，有人认为这种反应会导致蛋白质的毛细血管渗漏、水肿形成，甚至器官衰竭。然而，毛细血管渗漏综合征主要是一种临床诊断，尚未通过实际证明循环中蛋白质的渗漏得到证实。因此，我们测量了体外循环前后标记血浆蛋白的消失情况。
16例计划进行择期冠状动脉搭桥术的患者被纳入一项前瞻性对照研究。体外循环回路仅用晶体液预充。在体外循环前、期间和后3小时测定肿瘤坏死因子α、白细胞介素6、白细胞介素8、过敏毒素C3a和终末补体复合物C5b9水平。通过测量体外循环后第三小时期间及之前静脉注射伊文思蓝染料的消失情况，评估血浆蛋白从血管内隔室的跨血管逸出率。
体外循环后通过5种测量的介质可证明有显著的炎症反应。与基线值相比，白细胞介素6的最大增幅（36倍）。体外循环前后伊文思蓝染料的跨血管逸出率相似（7.6±0.6%/小时对7.3±0.6%/小时）。
上述数据证实了体外循环引起的全身炎症反应。与预期相反，比较体外循环前后的值时，伊文思蓝染料的跨血管逸出率没有变化。这些数据不支持体外循环后交换血管中蛋白质渗漏增加的概念。我们无法证明存在毛细血管渗漏综合征。
