Department of Anesthesiology and Surgery, Division of Anesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland.
Ann Thorac Surg. 2011 Jan;91(1):16-22. doi: 10.1016/j.athoracsur.2010.08.049.
The use of minimized cardiopulmonary bypass (MCPB) circuits has recently increased in an attempt to reduce the adverse effects of CPB. This prospective randomized study aimed to determine the effects of MCPB on retinal microembolization and related inflammatory, coagulation, and endothelial markers compared with conventional extracorporeal circulation (CCPB) among patients undergoing coronary artery bypass graft surgery.
Forty patients entered, and 37 patients completed the study. After the induction of anesthesia and immediately after the termination of CPB, standardized retinal fluorescein angiographs and digital images were obtained on both eyes and analyzed in a blinded fashion in terms of the CPB circuit. Blood samples for inflammatory, coagulation, and endothelial markers were collected at eight time points until the third postoperative day.
Postperfusion retinal fluorescein angiographs revealed microembolic perfusion defects in 2 of 18 in the MCPB group and in 9 of 18 in the CCPB group (p=0.027 [11% vs. 50%, difference 39%, confidence interval: 0.087 to 0.613, p=0.029]). Activation of polymorphonuclear leukocytes as measured with polymorphonuclear elastase was significantly decreased in the MCPB group. Other markers of inflammation, coagulation, and endothelial dysfunction increased comparably in both groups during CPB.
Retinal microembolization was found to be decreased after the use of minimized CPB compared with CCPB, suggesting a decreased embolic load to the brain after MCPB.
为了减少体外循环（CPB）的不良影响，最近越来越多地使用微创心肺旁路（MCPB）回路。本前瞻性随机研究旨在确定与常规体外循环（CCPB）相比，MCPB 对接受冠状动脉旁路移植术患者视网膜微栓塞及相关炎症、凝血和内皮标志物的影响。
40 例患者入组，37 例患者完成研究。在麻醉诱导后和 CPB 终止后即刻，对双眼进行标准化视网膜荧光血管造影和数字图像检查，并在盲法下根据 CPB 回路进行分析。在 8 个时间点采集血液样本，用于炎症、凝血和内皮标志物检测，直至术后第 3 天。
灌注后视网膜荧光血管造影显示，MCPB 组 18 例中有 2 例，CCPB 组 18 例中有 9 例出现微栓塞灌注缺陷（p=0.027 [11%比 50%，差异 39%，置信区间：0.087 至 0.613，p=0.029]）。MCPB 组多形核白细胞弹性蛋白酶活性显著降低。CPB 期间两组的其他炎症、凝血和内皮功能障碍标志物均相应增加。
与 CCPB 相比，使用微创 CPB 后发现视网膜微栓塞减少，提示 MCPB 后大脑栓塞负荷降低。
