Svitek Vladimir, Lonsky Vladimir, Mandak Jiri, Krejsek Jan, Kolackova Martina, Brzek Vladimir, Kubicek Jaroslav, Volt Martin, Bartos Michael, Harrer Jan
Department of Cardiac Surgery of Charles University in Prague, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec Kralove, Czech Republic.
Perfusion. 2009 Nov;24(6):389-95. doi: 10.1177/0267659109359437.
Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet.
A group of 54 patients who were indicated for elective coronary surgery were randomised into two groups - Group A (patients operated on using classic ECC - open modification) and Group B (patients operated on using mini-ECC). The concentrations of IL-6, PMN elastase and MCP-1 in both groups were monitored per- and postoperatively, along with the postoperative clinical course.
The groups did not differ in the basic pre- and peroperative characteristics. We recorded a lower priming for mini-ECC (p < 0.001) and significantly reduced hemodilution during ECC. There were no differences in the clinical outcome in either group. Serum concentrations of monitored markers of immune reaction towards ECC showed higher activity during standard ECC.
New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.
当前的研究致力于体外循环（ECC）系统的创新技术，以消除负面影响。一些研究表明，由于微型ECC技术设置的复杂性，与传统ECC相比，它们引发的免疫反应较弱。使用这些系统的临床益处尚未得到明确证实。
将一组54例择期冠状动脉手术患者随机分为两组——A组（使用传统ECC进行开放式改良手术的患者）和B组（使用微型ECC进行手术的患者）。对两组患者围手术期和术后的白细胞介素-6（IL-6）、中性粒细胞弹性蛋白酶和单核细胞趋化蛋白-1（MCP-1）浓度以及术后临床过程进行监测。
两组患者术前和术中的基本特征无差异。我们记录到微型ECC的预充量较低（p < 0.001），且体外循环期间血液稀释显著减少。两组的临床结局无差异。监测的ECC免疫反应标志物的血清浓度在标准ECC期间显示出较高活性。
微型系统中使用的新技术已被证明可降低免疫系统的激活，这可以通过促炎介质的动力学进行监测。尽管有这些可比的实验室结果，但在比较这两组低风险患者时，我们未发现短期临床结果存在差异。
