Vocelka Craig R, Jones Krystal M, Mikhova Krasimira M, Ebisu Ryan M, Shar Ashley, Kellum John A, Verrier Edward D, Rabkin David G
J Extra Corpor Technol. 2013 Dec;45(4):220-7.
Little is known about the effect of cardiopulmonary bypass alone on cardiac function; in an attempt to illuminate this relationship and test a possible mechanism, we used Cytosorb, a device capable of removing virtually all types of circulating cytokines to test the hypothesis that hemoadsorption of cytokines during bypass attenuates bypass-induced acute organ dysfunction. Twelve Yorkshire pigs (50-65 kg) were instrumented with a left ventricular conductance catheter. Baseline mechanics and cytokine expression (tumor necrosis factor [TNF], interleukin-6 [IL-6], and interleukin-10) were measured before and hourly after 1 hour of normothermic cardiopulmonary bypass. Animals underwent bypass without (cardiopulmonary bypass [CPB], n = 6) or with (CPB+HA, n = 6) the CytosorbTM device. Data were compared with "historical" controls (n = 6) that were similarly instrumented but underwent observation instead of bypass. Five hours after separation from bypass (or observation), animals were euthanized. Myocardial water content was determined postmortem. Neither TNF nor IL-6 was significantly elevated in either experimental group versus controls at any time point. Preload recruitable stroke work and dP/dtmax were significantly depressed immediately after separation from bypass in both CPB+HA and CPB and remained depressed for the duration of the experiment. Although Tau remained unchanged, dP/dTmin was significantly diminished in both bypass groups at all time points after separation from bypass. Cytokine hemoadsorption had no effect on any measurable index of function. Differences in postmortem data were not evident between groups. One hour of normothermic CPB results in a significant and sustained decline in left ventricular function that appears unrelated to changes in cytokine expression. Because we did not appreciate a significant change in cytokine concentrations postbypass, the capacity of cytokine hemoadsorption to attenuate CPB-induced ventricular dysfunction could not be assessed.
关于单纯心肺转流对心脏功能的影响，目前所知甚少；为了阐明这种关系并测试一种可能的机制，我们使用了Cytosorb，一种能够清除几乎所有类型循环细胞因子的装置，来检验体外循环期间细胞因子血液吸附可减轻体外循环诱导的急性器官功能障碍这一假设。12只约克夏猪（50 - 65千克）植入左心室电导导管。在常温心肺转流1小时之前及之后每小时测量基础力学和细胞因子表达（肿瘤坏死因子[TNF]、白细胞介素-6 [IL-6]和白细胞介素-10）。动物在未使用（心肺转流[CPB]，n = 6）或使用（CPB + HA，n = 6）CytosorbTM装置的情况下进行体外循环。数据与“历史”对照组（n = 6）进行比较，这些对照组同样植入了导管，但接受观察而非体外循环。从体外循环（或观察）结束后5小时，对动物实施安乐死。死后测定心肌含水量。在任何时间点，两个实验组与对照组相比，TNF和IL-6均未显著升高。在CPB + HA组和CPB组中，从体外循环结束后即刻开始，可预负荷的每搏功和dP/dtmax均显著降低，并在实验期间持续降低。虽然等容舒张期时间常数（Tau）保持不变，但在从体外循环结束后的所有时间点，两个体外循环组的dP/dTmin均显著降低。细胞因子血液吸附对任何可测量的功能指标均无影响。各实验组之间死后数据差异不明显。1小时的常温CPB导致左心室功能显著且持续下降，这似乎与细胞因子表达的变化无关。由于我们未发现体外循环后细胞因子浓度有显著变化，因此无法评估细胞因子血液吸附减轻CPB诱导的心室功能障碍的能力。
