Salamonsen Robert F, Anderson James, Anderson Michael, Bailey Michael, Magrin Geoff, Rosenfeldt Franklin
Department of Intensive Care, Alfred Hospital, Melbourne, Australia.
Ann Thorac Surg. 2005 Jun;79(6):2032-8. doi: 10.1016/j.athoracsur.2004.11.038.
Despite early promise as a means of reducing the inflammatory response to surgery and subsequent organ damage, the evidence of the clinical value of leukocyte filtration remains equivocal.
Three hundred patients presenting for routine coronary artery bypass surgery were randomized to a total leukocyte filtration group (filters in five different locations) and a control group with a standard 40-mum filter in the bypass return line only. Data on efficacy and safety of leukocyte filtration were collected by research and postoperative care staff who were blinded to the mode of filtration.
Leukofiltration achieved a transient fall in white cells immediately after surgery (p = 0.07) and a sustained fall in platelets, which was still significant on the second postoperative day (p = 0.0001). However, there were no significant differences in postoperative hospital stay, the primary outcome variable (p = 0.35), in ICU stay (p = 0.92), or mortality (p = 1.0). There were no differences in postoperative cardiac status including cardiac output (p = 0.16), inotrope (p = 0.93) or balloon pump (p = 0.48) requirement, or 24-hour troponin (p = 0.60). Similarly there were no differences in pulmonary or renal function (intubation time (p = 0.83), respiratory index (p = 0.19) rise in creatinine (p = 0.13) or hemofiltration (1.0)). Leukofitration was not associated with a statistically significant increase in bleeding or requirement for blood or blood products. It was associated with a decrease approaching significance (p = 0.1) in number and severity of postoperative wound infections. Three filters were blocked during use but were changed without incident or compromise to patient safety.
Leukocyte filtration is safe but not efficacious in improving short-term outcome.
尽管白细胞滤过术作为一种减少手术炎症反应及后续器官损伤的手段，早期曾被寄予厚望，但其临床价值的证据仍不明确。
300例行常规冠状动脉搭桥手术的患者被随机分为全白细胞滤过组（在五个不同位置使用滤器）和对照组，对照组仅在搭桥回流管中使用标准的40微米滤器。由对滤过方式不知情的研究及术后护理人员收集白细胞滤过术的疗效和安全性数据。
白细胞滤过术使术后即刻白细胞短暂下降（p = 0.07），血小板持续下降，术后第二天仍有显著差异（p = 0.0001）。然而，术后住院时间这一主要结局变量无显著差异（p = 0.35），重症监护病房（ICU）停留时间无显著差异（p = 0.92），死亡率也无显著差异（p = 1.0）。术后心脏状况包括心输出量（p = 0.16）、血管活性药物使用（p = 0.93）或球囊泵使用（p = 0.48）需求，以及24小时肌钙蛋白水平（p = 0.60）均无差异。同样，肺或肾功能也无差异（插管时间（p = 0.83）、呼吸指数（p = 0.19）、肌酐升高（p = 0.13）或血液滤过（p = 1.0））。白细胞滤过术与出血或血液及血液制品需求的统计学显著增加无关。术后伤口感染的数量和严重程度有接近显著的下降（p = 0.1）。使用过程中有三个滤器堵塞，但更换时未发生意外，也未危及患者安全。
白细胞滤过术安全，但在改善短期结局方面无效。
