慢性阻塞性肺疾病患者体外循环期间白细胞滤过的临床疗效

Clinical effectiveness of leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.

作者信息

Karaiskos Theodoros E, Palatianos George M, Triantafillou Constantine D, Kantidakis George H, Astras George M, Papadakis Emmanuel G, Vassili Mary I

机构信息

Third Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.

出版信息

Ann Thorac Surg. 2004 Oct;78(4):1339-44. doi: 10.1016/j.athoracsur.2004.04.040.

DOI:10.1016/j.athoracsur.2004.04.040

PMID:15464496

Abstract

BACKGROUND

We tested the hypothesis that leukocyte filtration during pulmonary reperfusion preserves pulmonary function and results in improved oxygenation after cardiopulmonary bypass (CPB) in patients with chronic obstructive pulmonary disease (COPD).

METHODS

In a prospective, randomized study, the treatment group consisted of 20 patients with COPD from consecutive open-heart procedures. A primed leukocyte filter was connected to the arterial line downstream of the standard arterial filter but was excluded from circulation. Circulated blood was directed through the leukocyte filter approximately 10 minutes before aortic cross-clamp removal and at early reperfusion for up to 30 minutes. These patients were compared to 20 additional COPD patients (controls) on whom systemic leukocyte filtration was not used during open-heart surgery.

RESULTS

There was no significant difference in gender, age, left ventricular ejection fraction, type of procedure, aortic cross-clamp time, perfusion time, preoperative FEV1 and preoperative respiratory index (Pao2/FiO2 ratio) between treatment and control groups. The respiratory index changed in the treatment group by +9.8% of baseline after completion of CPB, by -14.2% upon arrival in the intensive care unit (ICU), and by -19.6% 12 hours later, whereas in the control group, it changed by -14.5% (p < 0.05), -27.7%, and -24%, respectively. Leukocyte-depleted patients required shorter intubation time (20.4 +/- 16.1 hours), ICU stay (46.2 +/- 40.1 hours) and length of hospitalization (8.3 +/- 2.8 days) than controls (29.5 +/- 21.9 hours, p < 0.05; 75.5 +/- 34.9 hours, p < 0.005; and 10.4 +/- 3.5 days, p < 0.05, respectively). Surgical (30-day) mortality was zero in both groups.

CONCLUSIONS

In COPD patients having CPB, systemic leukocyte depletion at early reperfusion was associated with better oxygenation, shorter intubation time, and shorter ICU and hospital stays. Leukocyte filtration during CPB most likely preserves pulmonary function by ameliorating pulmonary reperfusion injury.

摘要

背景

我们检验了这样一个假设，即在慢性阻塞性肺疾病（COPD）患者体外循环（CPB）期间，肺再灌注时进行白细胞滤过可保护肺功能并改善氧合。

方法

在一项前瞻性随机研究中，治疗组由20例连续接受心脏直视手术的COPD患者组成。一个预充式白细胞滤器连接到标准动脉滤器下游的动脉管路上，但不参与循环。在主动脉阻断钳移除前约10分钟以及早期再灌注时，使循环血液流经白细胞滤器长达30分钟。将这些患者与另外20例COPD患者（对照组）进行比较，后者在心脏直视手术期间未进行全身白细胞滤过。

结果

治疗组与对照组在性别、年龄、左心室射血分数、手术类型、主动脉阻断时间、灌注时间、术前第一秒用力呼气容积（FEV1）和术前呼吸指数（动脉血氧分压/吸入氧分数值比值）方面均无显著差异。治疗组在CPB结束后呼吸指数较基线升高9.8%，进入重症监护病房（ICU）时降低14.2%，12小时后降低19.6%，而对照组分别降低14.5%（p<0.05）、27.7%和24%。与对照组相比，白细胞去除的患者插管时间（20.4±16.1小时）、ICU住院时间（46.2±40.1小时）和住院时间（8.3±2.8天）更短（分别为29.5±21.9小时，p<0.05；75.5±34.9小时，p<0.005；10.4±3.5天，p<0.05）。两组手术（30天）死亡率均为零。