Baufreton C, Corbeau J-J, Pinaud F
Service de Chirurgie Cardiaque et Département d'Anesthésie-Réanimation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
Ann Fr Anesth Reanim. 2006 May;25(5):510-20. doi: 10.1016/j.annfar.2005.12.002. Epub 2006 Feb 20.
The systemic inflammatory response in cardiac surgery is closely related to the haemostasis disturbances. It is responsible of a significant morbidity and mortality that was previously suspected to be caused by cardiopulmonary bypass alone. However, it is time now to clearly identify the factors that are material-dependent from that material-independent. From this point of view, off-pump surgery allowed for better comprehension of the multiple sources of the inflammatory response. Numerous pathways are activated, involving complement, platelets, neutrophiles and monocytes. The tissue pathway of the coagulation system, through tissue factor, is of major importance and has to be surgically considered in order to reduce the whole body inflammatory response postoperatively. The quality of the extracorporeal perfusion through its consequences on organ perfusion, particularly in the splanchnic area, also participates to this pathophysiological process. Beyond the progress of technology provided by the industry, particularly the minimally extracorporeal circulation derived from off-pump surgery evolution, the surgical approach is of major importance in the control of the systemic inflammatory response and must not be ignored yet.
心脏手术中的全身炎症反应与止血功能紊乱密切相关。它是导致显著发病率和死亡率的原因，此前人们怀疑这仅由体外循环引起。然而，现在是时候明确区分物质依赖性因素和非物质依赖性因素了。从这一角度来看，非体外循环手术有助于更好地理解炎症反应的多种来源。众多途径被激活，涉及补体、血小板、中性粒细胞和单核细胞。凝血系统的组织途径通过组织因子发挥作用，至关重要，必须在手术中加以考虑，以减轻术后全身炎症反应。体外循环灌注的质量通过其对器官灌注（尤其是内脏区域）的影响，也参与了这一病理生理过程。除了行业提供的技术进步，特别是源自非体外循环手术发展的微创体外循环，手术方式在控制全身炎症反应方面也至关重要，绝不能被忽视。
