Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University Hospital Düsseldorf, Germany.
Hellenic J Cardiol. 2011 Nov-Dec;52(6):493-500.
Perioperative systemic inflammatory response syndrome (SIRS) remains a catastrophe in cardiac surgery and adequate patient screening is still lacking. We present a prospective trial starting with preoperative data collection. For the first time, the postoperative outcomes of patients after open-heart surgery are evaluated to predict a hazard-constellation for the patient at risk of developing SIRS.
Of 2315 patients undergoing cardiac surgery over a 2-year period, 107 were considered likely to develop perioperative SIRS based on a high-risk stratification; 12 of them actually developed SIRS and were recruited for this study. Another 20 uneventful consecutive patients served as controls. Blood samples were collected from before the induction of anaesthesia until the morning of the second postoperative day and were analysed for complement, cytokines, adhesion-molecules, endothelin-1 (ET-1), plasminogen-activatorinhibitor (PAI), the coagulation and fibrinolysis cascade and routine laboratory analysis.
Significant preoperative differences were observed in leukocytes, lymphocytes, alkaline phosphatase,ICAM-3 and VCAM-1 (p<0.05). Significant positive correlations were found for ET-1 and lactate in the SIRS group. The increase in these parameters was correlated with a prolonged duration of extracorporeal circulation. The best predictive combination for SIRS consisted of alkaline phosphatase, ET-1, ICAM-1, -2, -3, VCAM-1 and ELAM-1.
The results suggest a new theory regarding the development of perioperative SIRS. It is not the extracorporeal circulation itself that represents the main trigger, but rather an a priori activation of the endothelial cells, lymphocytes and leukocytes. This activation impairs the microcirculation and finally leads to multi-organ failure. The current data allow the identification of the patient at risk and can thus influence the individual operative schedule.
围手术期全身炎症反应综合征（SIRS）仍然是心脏手术的一大灾难，目前仍缺乏充分的患者筛选方法。我们进行了一项前瞻性试验，从术前数据收集开始。我们首次评估了心脏直视手术后患者的术后转归，以预测发生 SIRS 的高危患者的危险组合。
在 2 年期间，对 2315 例行心脏手术的患者进行了研究，根据高危分层，有 107 例患者可能发生围手术期 SIRS；其中 12 例患者实际上发生了 SIRS，并被纳入本研究。另外 20 例无并发症的连续患者作为对照。在麻醉诱导前至术后第 2 天清晨采集血样，并分析补体、细胞因子、黏附分子、内皮素-1（ET-1）、纤溶酶原激活物抑制剂（PAI）、凝血和纤溶级联反应以及常规实验室分析。
在 SIRS 组中观察到白细胞、淋巴细胞、碱性磷酸酶、ICAM-3 和 VCAM-1 术前存在显著差异（p<0.05）。在 SIRS 组中，ET-1 和乳酸呈显著正相关。这些参数的增加与体外循环时间延长相关。SIRS 的最佳预测组合包括碱性磷酸酶、ET-1、ICAM-1、-2、-3、VCAM-1 和 ELAM-1。
结果提出了一种关于围手术期 SIRS 发展的新理论。体外循环本身并不是主要触发因素，而是内皮细胞、淋巴细胞和白细胞的预先激活。这种激活损害了微循环，最终导致多器官衰竭。目前的数据允许识别高危患者，从而影响个体手术计划。
