Heerdt E M, Fransen E J, Maessen J G, de Jong D S
Department of Extra-Corporeal Circulation, University Hospital Maastricht, The Netherlands.
Perfusion. 2004 Jan;19(1):3-5. doi: 10.1191/0267659104pf699cs.
In this study, we examined whether leukocyte depletion from the residual heart-lung machine blood at the end of cardiopulmonary bypass (CPB) has an effect on the leukocyte counts in the systemic circulation. Twenty-six patients undergoing coronary artery bypass grafting (CABG) were randomly allocated to a leukocyte-depletion group or a control group. In the leukocyte-depletion group (n = 13), all residual blood (400 mL to 1.4 L) was filtered by leukocyte-removal filters (Pall RS01) and reinfused to the patient after CPB, whereas, in the control group, an identical amount of residual blood after bypass was reinfused without filtration (n = 13). Leukocyte-depleted allogeneic blood was transfused if needed. Preoperative risk profiles, pump support and duration of aortic crossclamping time were identical in both patient groups (ns). Leukocyte depletion removed more than 96% of leukocytes from the residual retransfused blood (p < 0.01) and significantly reduced circulating leukocytes (p < 0.05) compared with the control group. Remarkably, lower numbers of circulating leukocytes were found, not at 1 hour after reinfusion, but at 4 and 8 hours after reinfusion (p < 0.05). There were no statistical differences between the two groups with respect to postoperative blood loss, the number of transfused packed red cells and mechanical ventilation time. These results show that leukocytes can be removed from the residual blood of the heart-lung machine after CPB very effectively. Furthermore, this leukocyte depletion results in a long-term effect, the clinical significance of which has to be elucidated in ongoing studies.
在本研究中，我们检测了体外循环（CPB）结束时从心肺机剩余血液中去除白细胞是否会对体循环中的白细胞计数产生影响。26例行冠状动脉旁路移植术（CABG）的患者被随机分为白细胞去除组和对照组。在白细胞去除组（n = 13）中，所有剩余血液（400 mL至1.4 L）均通过白细胞去除滤器（颇尔RS01）过滤，并在CPB后回输给患者，而在对照组中，等量的旁路后剩余血液未经过滤直接回输（n = 13）。如有需要，输注去除白细胞的异体血。两组患者的术前风险概况、泵支持及主动脉阻断时间相同（无统计学差异）。与对照组相比，白细胞去除可从再输注的剩余血液中去除超过96%的白细胞（p < 0.01），并显著降低循环白细胞水平（p < 0.05）。值得注意的是，循环白细胞数量降低并非在再输注后1小时出现，而是在再输注后4小时和8小时出现（p < 0.05）。两组在术后失血量、输注红细胞悬液数量及机械通气时间方面无统计学差异。这些结果表明，CPB后可非常有效地从心肺机剩余血液中去除白细胞。此外，这种白细胞去除具有长期效应，其临床意义有待正在进行的研究阐明。
