de Vroege Roel, Huybregts Rien, van Oeveren Wim, van Klarenbosch Jan, Linley Gerard, Mutlu Jihan, Jansen Evert, Hack Erik, Eijsman Leon, Wildevuur Charles
Department of Extracorporeal Circulation, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands.
Artif Organs. 2005 Jun;29(6):490-7. doi: 10.1111/j.1525-1594.2005.29083.x.
This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused with either a heparin-coated or an uncoated circuit. During bypass the mean arterial pressure was maintained as near as possible to 60 mm Hg. Mediators for inflammation, hemodynamic, and oxygen parameters were determined during and after bypass. To reach the target mean arterial pressure in the first hour of bypass the pump flow in the uncoated group had to be increased (P<0.05), consequently the systemic vascular resistance index decreased (P<0.05). After bypass more inotropic support was necessary in this group to reach this pressure. In the coated group less bradykinin, complement activation, and elastase was generated during bypass (P<0.05). The results of this study suggest that heparin coating not only improves biocompatibility, but also ameliorates the hemodynamic instability during and after bypass.
本研究旨在探讨肝素涂层体外循环回路能否在心肺转流期间及之后减少全身炎症反应以及随后血管活性物质的释放。51例计划行冠状动脉旁路移植术的患者分别使用肝素涂层回路或未涂层回路进行灌注。转流期间平均动脉压尽可能维持在60 mmHg左右。在转流期间及之后测定炎症、血流动力学和氧参数的介质。为了在转流的第一小时达到目标平均动脉压，未涂层组的泵流量必须增加（P<0.05），因此全身血管阻力指数下降（P<0.05）。转流后，该组需要更多的正性肌力支持才能达到该压力。在涂层组中，转流期间产生的缓激肽、补体激活物和弹性蛋白酶较少（P<0.05）。本研究结果表明，肝素涂层不仅能改善生物相容性，还能改善转流期间及之后的血流动力学不稳定。
