Dapper F, Neppl H, Wozniak G, Strube I, Boldt J, Hehrlein F W, Neuhof H
Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, FRG.
Eur J Cardiothorac Surg. 1992;6(1):18-24. doi: 10.1016/1010-7940(92)90093-d.
The influence of four different membrane oxygenators (HF 4000, BOS-CM 50, CML 2, Maxima) on leucocyte count, concentrations of PMN-elastase, clotting factor XII, AT-III, C1-INH, alpha 2-antiplasmin and C3a was registered before, during and after CPB with pulsatile and nonpulsatile flow in 80 male patients aged between 36 and 67 years. With all systems tested, there was a drop in the concentrations of clotting factor XII, AT-III, C1-INH and alpha 2-antiplasmin in the early extracorporeal circulation (ECC) phase, exceeding the average hematocrit reduction accounted for by dilution. This drop was the least distinct with CML 2 systems, both with pulsatile and nonpulsatile perfusion, indicating system-inherent influences. Leucocyte cound and PMN-elastase concentration rose significantly during ECC irrespective of oxygenator tested of flow type applied. The rise in leucocyte count even continued for about 4 h after ECC. During the first 40 min of ECC, these changes were paralleled by a significant rise in C3a concentration, suggesting complement activation as a main cause for PMN activation. However, there is reason to suppose involvement of further mechanisms operating in PMN activation, since the elevated C3a-concentrations began to fall off while leucocyte count and PMN-elastase concentrations were still increasing.
在80例年龄在36至67岁之间的男性患者中，记录了四种不同的膜式氧合器（HF 4000、BOS-CM 50、CML 2、Maxima）在体外循环（CPB）期间及前后，采用搏动流和非搏动流时对白细胞计数、PMN弹性蛋白酶、凝血因子XII、抗凝血酶III（AT-III）、C1酯酶抑制剂（C1-INH）、α2-抗纤溶酶和C3a浓度的影响。在所有测试系统中，凝血因子XII、AT-III、C1-INH和α2-抗纤溶酶的浓度在体外循环（ECC）早期阶段下降，下降幅度超过了因稀释导致的平均血细胞比容降低。无论是搏动灌注还是非搏动灌注，CML 2系统的这种下降最不明显，表明存在系统固有影响。无论测试的氧合器类型或应用的血流类型如何，ECC期间白细胞计数和PMN弹性蛋白酶浓度均显著升高。白细胞计数在ECC后甚至持续升高约4小时。在ECC的前40分钟内，这些变化伴随着C3a浓度的显著升高，提示补体激活是PMN激活的主要原因。然而，有理由推测在PMN激活过程中还涉及其他机制，因为当白细胞计数和PMN弹性蛋白酶浓度仍在升高时，升高的C3a浓度开始下降。
