Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Quebec, Canada.
Crit Care Med. 2013 Aug;41(8):e171-8. doi: 10.1097/CCM.0b013e31828a2354.
In many pathological conditions, including high-risk surgery, the severity of the inflammatory response is related to the patient outcome. However, determining the patient inflammatory state presents difficulties, as markers are obtained intermittently through blood testing with long delay. RBC aggregation is a surrogate marker of inflammation that can be quantified with the ultrasound Structure Factor Size and Attenuation Estimator. The latter is proposed as a real-time inflammation monitoring technique for patient care.
Ten swine underwent a 90-minute cardiopulmonary bypass, and surveillance was maintained during 120 minutes in the postbypass period. To promote the inflammatory reaction, lipopolysaccharide was administrated two times prior to surgery in six of those swine (lipopolysaccharide group). During the whole procedure, the Structure Factor Size and Attenuation Estimator cellular imaging method displayed a RBC aggregation index (W) computed from images acquired within the pump circuit and the femoral vein. Interleukin-6, interleukin-10, C-reactive protein, haptoglobin, immunoglobulin G, and fibrinogen concentrations were measured at specific periods.
Compared with controls, the lipopolysaccharide group exhibited higher W within the pump circuit (p < 0.05). In the femoral vein, W was gradually amplified in the lipopolysaccharide group during cardiopulmonary bypass and the postbypass period (p < 0.05), whereas interleukin levels were higher in the lipopolysaccharide group but only at the end of cardiopulmonary bypass and beginning of postbypass (p < 0.05).
Continuous RBC aggregation monitoring can characterize the evolving inflammatory response during and after cardiopulmonary bypass. The Structure Factor Size and Attenuation Estimator is proposed as a real-time noninvasive monitoring technique to anticipate inflammation-related complications during high-risk surgery or critical care situations. Because RBC aggregation promotes vascular resistance and thrombosis, W could also provide early information on vascular disorders in those clinical situations.
在许多病理情况下，包括高危手术，炎症反应的严重程度与患者的预后相关。然而，确定患者的炎症状态存在困难，因为标志物是通过血液检测间歇性获得的，且具有较长的延迟。红细胞聚集是炎症的替代标志物，可以通过超声结构因子大小和衰减估计器进行定量。后者被提议作为一种实时炎症监测技术用于患者护理。
10 头猪接受了 90 分钟的心肺旁路手术，在旁路手术后的 120 分钟内进行监测。为了促进炎症反应，在手术前两次给予 6 头猪（脂多糖组）脂多糖。在整个过程中，结构因子大小和衰减估计器细胞成像方法显示了从泵回路和股静脉内采集的图像计算出的红细胞聚集指数（W）。在特定时期测量白细胞介素 6、白细胞介素 10、C 反应蛋白、触珠蛋白、免疫球蛋白 G 和纤维蛋白原的浓度。
与对照组相比，脂多糖组在泵回路中的 W 较高（p < 0.05）。在股静脉中，W 在心肺旁路和旁路后期间逐渐在脂多糖组中放大（p < 0.05），而白细胞介素水平在脂多糖组中较高，但仅在心肺旁路结束和旁路开始时（p < 0.05）。
连续的红细胞聚集监测可以描述心肺旁路期间和之后不断变化的炎症反应。结构因子大小和衰减估计器被提议作为一种实时的非侵入性监测技术，以预测高危手术或重症监护情况下与炎症相关的并发症。由于红细胞聚集会增加血管阻力和血栓形成，因此 W 还可以提供这些临床情况下血管疾病的早期信息。
