Aydin Naz Bige, Gercekoglu Hakan, Aksu Burak, Ozkul Vedat, Sener Tufan, Kiygil Ilknur, Turkoglu Tansel, Cimen Serdar, Babacan Funda, Demirtas Murat
Division of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Marmara, Istanbul, Turkey.
J Thorac Cardiovasc Surg. 2003 Apr;125(4):843-8. doi: 10.1067/mtc.2003.323.
The endotoxemia associated with cardiac surgery is thought to be dominantly influenced by the use of cardiopulmonary bypass. The objectives of this study were to assess the relative contribution of cardiopulmonary bypass on endotoxemia apart from cardiac surgical access and to improve our understanding of the potential benefits of off-pump procedures.
Thirty patients undergoing coronary artery bypass grafting were followed up prospectively. The patients were divided into 2 equal groups: those who underwent bypass grafting through a sternotomy incision without cardiopulmonary bypass (off-pump group) and those who underwent bypass grafting through a sternotomy incision with cardiopulmonary bypass (CPB group). Blood sampling for endotoxin, lactate, and cardiac index measurements were performed during the following time points: (1) after sternotomy; (2) during the coronary occlusion period in the off-pump group and during aortic clamping in the CPB group; (3) after removal of the coronary occlusion sutures in the off-pump group and after removal of the aortic clamp in the CPB group; (4) 30 minutes after the completion of all distal anastomoses in the off-pump group and immediately after weaning from cardiopulmonary bypass in the CPB group; (5) 1 hour postoperatively; and (6) 12 hours postoperatively.
Endotoxin and lactate levels were significantly (P <.05) lower in the off-pump group at all sampling time points, except after sternotomy.
In conclusion, this study has shown that endotoxemia during coronary artery bypass surgery seems mainly to be associated with cardiopulmonary bypass procedure. The relatively lower endotoxin levels observed in off-pump surgery might contribute to improved postoperative recovery.
与心脏手术相关的内毒素血症被认为主要受体外循环使用的影响。本研究的目的是评估体外循环对除心脏手术入路之外的内毒素血症的相对贡献，并增进我们对非体外循环手术潜在益处的理解。
对30例行冠状动脉旁路移植术的患者进行前瞻性随访。患者被分为两组，每组人数相等：一组通过胸骨切开术切口在非体外循环下进行旁路移植术（非体外循环组），另一组通过胸骨切开术切口在体外循环下进行旁路移植术（体外循环组）。在以下时间点采集血样以测量内毒素、乳酸和心脏指数：（1）胸骨切开术后；（2）非体外循环组冠状动脉阻断期间和体外循环组主动脉阻断期间；（3）非体外循环组移除冠状动脉阻断缝线后和体外循环组移除主动脉夹后；（4）非体外循环组完成所有远端吻合术后30分钟和体外循环组脱离体外循环后即刻；（5）术后1小时；（6）术后12小时。
除胸骨切开术后外，非体外循环组在所有采样时间点的内毒素和乳酸水平均显著较低（P <.05）。
总之，本研究表明冠状动脉旁路手术期间的内毒素血症似乎主要与体外循环手术有关。非体外循环手术中观察到的相对较低的内毒素水平可能有助于改善术后恢复。
