Murphy G J, Angelini G D
Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
J Card Surg. 2004 Nov-Dec;19(6):481-8. doi: 10.1111/j.0886-0440.2004.04101.x.
Despite many years of clinical and experimental research, the contribution of cardiopulmonary bypass (CPB) and cardioplegic arrest to morbidity and mortality following cardiac surgery remains unclear. This is due, in part, to lack of suitable control group against which bypass and cardioplegic arrest can be compared. The recent success of beating heart coronary artery bypass grafting has, however, for the first time, provided an opportunity to compare the same operation, in similar patient groups, with, or without CPB and cardioplegic arrest. CPB is associated with an acute phase reaction of protease cascades, leucocyte, and platelet activation that result in tissue injury. This is largely manifest as subclinical organ dysfunction that produces a clinical effect in those patients that generate an excessive inflammatory response or in those with limited functional reserve. The contribution of myocardial ischemia/reperfusion, secondary to aortic cross-clamping, and cardioplegic arrest, to the systemic inflammatory response and wider organ dysfunction is unknown, and requires further evaluation in clinical trials.
尽管经过多年的临床和实验研究，但体外循环（CPB）和心脏停搏对心脏手术后发病率和死亡率的影响仍不明确。部分原因在于缺乏合适的对照组来与体外循环和心脏停搏进行比较。然而，不停跳冠状动脉搭桥术最近取得的成功首次提供了一个机会，可在相似患者群体中比较相同手术在有或没有体外循环和心脏停搏情况下的差异。体外循环与蛋白酶级联反应、白细胞和血小板激活的急性期反应相关，会导致组织损伤。这在很大程度上表现为亚临床器官功能障碍，在那些产生过度炎症反应的患者或功能储备有限的患者中产生临床效应。主动脉交叉阻断及心脏停搏继发的心肌缺血/再灌注对全身炎症反应和更广泛的器官功能障碍的影响尚不清楚，需要在临床试验中进一步评估。
