Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
J Cardiothorac Vasc Anesth. 2012 Aug;26(4):557-62. doi: 10.1053/j.jvca.2012.04.010. Epub 2012 May 30.
Cardiopulmonary bypass (CPB) systems without a venous reservoir rarely are adopted clinically. The effects of a biocompatible CPB system with a venous reservoir were evaluated on the activation of the coagulation and inflammatory systems.
A prospective, randomized controlled trial.
A university hospital (single center).
Eighty-three coronary artery bypass graft (CABG) surgery patients were assigned to the Physio group (closed venous reservoir, phosphorylcholine coating, and no cardiotomy suction) or the Standard group (open, noncoated, and cardiotomy suction used).
Blood samples were obtained at 6 different time points before, during, and after surgery. Nuclear factor-kB (NF-κB) was evaluated before surgery and 2 and 24 hours after surgery. Myocardial damage was evaluated measuring cardiac troponin I.
Interleukin (IL)-6 (a marker of inflammation), prothrombin fragment 1-2 (PF-1.2, a marker of thrombin generation), plasmin-antiplasmin complex (PAP, a marker of fibrinolysis), and platelet factor 4 (PF4, a marker of platelet activation) were measured. The DNA binding activity of proinflammatory transcription factor NF-κB was quantified in the isolated lymphomonocyte cells. Surgery caused changes of all plasma biomarkers. This reaction was attenuated strongly in the Physio group; PF-1.2, PAP, and PF4 all were decreased significantly. In the Physio group, a significantly lower cardiac troponin I release was observed postoperatively. After surgery, NF-κB activity was reduced in the Physio group although this difference was not statistically significant.
A multimodal strategy using a closed and phosphorylcholine-coated CPB circuit together with the avoidance of cardiotomy suction reduced activation of the coagulation and fibrinolytic systems intraoperatively, although these changes did not persist postoperatively. However, no difference in clinical outcome was appreciated on a larger scale.
无静脉贮血器的体外循环（CPB）系统很少在临床上采用。本研究评估了一种具有静脉贮血器的生物相容性 CPB 系统对凝血和炎症系统激活的影响。
前瞻性、随机对照试验。
一所大学医院（单中心）。
83 例冠状动脉旁路移植术（CABG）患者被分为 Physio 组（封闭静脉贮血器、磷酰胆碱涂层、无心脏吸引）和 Standard 组（开放、非涂层、使用心脏吸引）。
在手术前、手术中和手术后的 6 个不同时间点采集血样。在手术前和手术后 2 小时和 24 小时评估核因子-kB（NF-κB）。通过测量心肌肌钙蛋白 I 来评估心肌损伤。
测量白细胞介素（IL）-6（炎症标志物）、凝血酶原片段 1-2（PF-1.2，凝血酶生成标志物）、纤溶酶-抗纤溶酶复合物（PAP，纤维蛋白溶解标志物）和血小板因子 4（PF4，血小板激活标志物）。定量测定分离的淋巴单核细胞中促炎转录因子 NF-κB 的 DNA 结合活性。手术引起所有血浆生物标志物的变化。在 Physio 组中，这种反应被强烈抑制；PF-1.2、PAP 和 PF4 均显著降低。在 Physio 组中，术后观察到肌钙蛋白 I 释放明显减少。手术后，Physio 组 NF-κB 活性降低，尽管这一差异无统计学意义。
使用封闭的、磷酰胆碱涂层的 CPB 回路和避免心脏吸引的多模式策略可减少手术期间凝血和纤维蛋白溶解系统的激活，尽管这些变化在术后并未持续存在。然而，在更大范围内，临床结果没有差异。
