使用小型化电路和无血预充以减少婴儿体外循环后中性粒细胞介导的器官功能障碍。

Using a miniaturized circuit and an asanguineous prime to reduce neutrophil-mediated organ dysfunction following infant cardiopulmonary bypass.

作者信息

Karamlou Tara, Schultz Jess M, Silliman Chris, Sandquist Chloe, You Jamie, Shen Irving, Ungerleider Ross M

机构信息

Division of Pediatric Cardiac Surgery and Pediatric Perfusion Services, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon 97201, USA.

出版信息

Ann Thorac Surg. 2005 Jul;80(1):6-13; discussion 13-4. doi: 10.1016/j.athoracsur.2005.02.030.

DOI:10.1016/j.athoracsur.2005.02.030

PMID:15975331

Abstract

BACKGROUND

Contemporary infant cardiopulmonary bypass circuits require a blood prime. Blood, especially when stored, generates an inflammatory response, and may contribute to organ dysfunction following cardiopulmonary bypass. We determined whether using a miniaturized circuit and an asanguineous prime attenuated the post-bypass inflammatory response, and improved right ventricular and pulmonary function.

METHODS

Sixteen infant piglets were placed into 3 groups based on prime components: group I (fresh blood), group II (stored blood), and group III (miniaturized circuit and asanguineous prime). Piglets were placed on cardiopulmonary bypass (100 mL.kg(-1).min(-1)), cooled to 18 degrees C, and underwent continuous perfusion (50 mL.kg(-1).min(-1)) for 30 minutes. They were rewarmed and separated from bypass. Serum tumor necrosis factor-alpha, right ventricular function, and pulmonary function were measured before and 30 minutes after bypass. Neutrophil priming activity in fresh and stored donor blood was also assessed.

RESULTS

Animals in group III had significantly improved cardiopulmonary function than the groups receiving blood (right ventricular cardiac index [mL.kg(-1).min(-1)]: group I [18.8 +/- 4.8], group II [21.5 +/- 6.2], and group III [81.2 +/- 11.4], p < 0.001; and pulmonary vascular resistance index [dynes.mL(-1).kg(-1)]: group I [1169 +/- 409], group II [1610 +/- 486], and group III [214 +/- 63], p = 0.03). Tumor necrosis factor-alpha (pg.mL(-1)) was lower in group III (1465 +/- 39) than in the groups receiving blood (3940 +/- 777), p = 0.002. Neutrophil priming activity (nmol.min(-1)) was also higher in stored blood (3.7 +/- 6) than in fresh blood (1.9 +/- 0.2), p = 0.02.

CONCLUSIONS

We have devised a unique miniaturized circuit that allows an asanguineous prime without hemodilution in an infant swine model. The employment of this circuit attenuates the post-bypass inflammatory response and has salutary effects on cardiopulmonary function.

摘要

背景

当代婴幼儿体外循环回路需要血液预充。血液，尤其是储存后的血液，会引发炎症反应，并可能导致体外循环后器官功能障碍。我们确定使用小型化回路和无血预充液是否能减轻体外循环后的炎症反应，并改善右心室和肺功能。

方法

16只幼猪根据预充液成分分为3组：I组（新鲜血液）、II组（储存血液）和III组（小型化回路和无血预充液）。将幼猪置于体外循环（100 mL·kg⁻¹·min⁻¹），冷却至18℃，并进行持续灌注（50 mL·kg⁻¹·min⁻¹）30分钟。然后复温并脱离体外循环。在体外循环前和体外循环后30分钟测量血清肿瘤坏死因子-α、右心室功能和肺功能。还评估了新鲜和储存供体血液中的中性粒细胞激活活性。

结果

III组动物的心肺功能明显优于接受血液预充的组（右心室心指数[mL·kg⁻¹·min⁻¹]：I组[18.8±4.8]，II组[21.5±6.2]，III组[81.2±11.4]，p<0.001；肺血管阻力指数[dynes·mL⁻¹·kg⁻¹]：I组[1169±409]，II组[1610±486]，III组[214±63]，p = 0.03）。III组的肿瘤坏死因子-α（pg·mL⁻¹）（1465±39）低于接受血液预充的组（3940±777），p = 0.002。储存血液中的中性粒细胞激活活性（nmol·min⁻¹）（3.7±6）也高于新鲜血液（1.9±0.2），p =