Jansen N J, van Oeveren W, Gu Y J, van Vliet M H, Eijsman L, Wildevuur C R
Department of Cardiopulmonary Surgery Research Division, University Hospital Groningen, The Netherlands.
Ann Thorac Surg. 1992 Oct;54(4):744-7; discussion 747-8. doi: 10.1016/0003-4975(92)91021-z.
Endotoxin, when released into the systemic circulation during cardiopulmonary bypass (CPB), might induce activation of plasmatic systems and blood cells during CPB, in addition to a material-dependent blood activation during CPB. However, the role of endotoxin in the development of this so-called whole-body inflammatory reaction in CPB is still unclear. We investigated the release of endotoxin into the systemic circulation in relation with the activation of the complement system and in particular the formation of tumor necrosis factor in 10 patients undergoing CPB. Immediately after the start of CPB the endotoxin concentrations increased significantly (p less than 0.01), accompanied by increases in C3a concentration (p less than 0.05). After release of the aortic cross-clamp, there was a second increase in endotoxin followed by a continuous increase in tumor necrosis factor, reaching a peak concentration 1 hour after the end of CPB (p less than 0.01). These observations demonstrate a release of endotoxin into the systemic circulation associated with tumor necrosis factor formation, which contributes to the whole-body inflammatory reaction associated with CPB.
在体外循环（CPB）期间，内毒素释放到体循环中，除了会在CPB期间引发与物质相关的血液激活外，还可能导致CPB期间血浆系统和血细胞的激活。然而，内毒素在CPB中这种所谓的全身炎症反应发展过程中的作用仍不明确。我们研究了10例接受CPB的患者体内内毒素释放到体循环的情况，及其与补体系统激活特别是肿瘤坏死因子形成的关系。CPB开始后立即出现内毒素浓度显著升高（p<0.01），同时C3a浓度升高（p<0.05）。主动脉阻断钳松开后，内毒素再次升高，随后肿瘤坏死因子持续升高，在CPB结束后1小时达到峰值浓度（p<0.01）。这些观察结果表明，内毒素释放到体循环中与肿瘤坏死因子的形成有关，这促成了与CPB相关的全身炎症反应。
