Kohira Satoshi, Oka Norihiko, Inoue Nobuyuki, Itatani Keiichi, Kitamura Tadashi, Horai Tetsuya, Oshima Hiroyuki, Tojo Keiichi, Yoshitake Shigenori, Miyaji Kagami
Medical Engineering Center, Kitasato University School of Medicine, Sagamihara, Japan.
Artif Organs. 2014 Dec;38(12):1018-23. doi: 10.1111/aor.12311. Epub 2014 Apr 21.
Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. Our previous reports revealed that prophylactic sivelestat administration at CPB initiation suppresses the postoperative acute inflammatory response due to CPB in pediatric cardiac surgery. The purpose of this study was to compare the effects of sivelestat administration before CPB and at CPB initiation in patients undergoing pediatric open-heart surgery. Twenty consecutive patients weighing 5-10 kg and undergoing ventricular septal defect closure with CPB were divided into pre-CPB (n = 10) and control (n = 10) groups. Patients in the pre-CPB group received a 24 h continuous intravenous infusion of 0.2 mg/kg/h sivelestat starting at the induction of anesthesia and an additional 0.1 mg/100 mL during CPB priming. Patients in the control group received a 24-h continuous intravenous infusion of 0.2 mg/kg/h sivelestat starting at the commencement of CPB. Blood samples were tested. Clinical variables including blood loss, water balance, systemic vascular resistance index, and the ratio between partial pressure of oxygen and fraction of inspired oxygen (P/F ratio) were assessed. White blood cell count and neutrophil count as well as C-reactive protein levels were significantly lower in the pre-CPB group according to repeated two-way analysis of variance, whereas platelet count was significantly higher. During CPB, mixed venous oxygen saturation remained significantly higher and lactate levels lower in the pre-CPB group. Postoperative alanine aminotransferase and blood urea nitrogen levels were significantly lower in the pre-CPB group than in the control group. The P/F ratio was significantly higher in the pre-CPB group than in the control group. Fluid load requirement was significantly lower in the pre-CPB group.Administration of sivelestat before CPB initiation is more effective than administration at initiation for the suppression of inflammatory responses due to CPB in pediatric open-heart surgery, with this effect being confirmed by clinical evidence.
体外循环（CPB）会引发全身炎症反应。我们之前的报告显示，在CPB开始时预防性给予西维来司他可抑制小儿心脏手术中因CPB引起的术后急性炎症反应。本研究的目的是比较在小儿心脏直视手术患者中，CPB前和CPB开始时给予西维来司他的效果。连续20例体重5 - 10 kg且接受CPB下室间隔缺损修补术的患者被分为CPB前组（n = 10）和对照组（n = 10）。CPB前组患者在麻醉诱导时开始接受24小时持续静脉输注西维来司他，剂量为0.2 mg/kg/h，并在CPB预充期间额外给予0.1 mg/100 mL。对照组患者从CPB开始时接受24小时持续静脉输注西维来司他，剂量为0.2 mg/kg/h。采集血样进行检测。评估包括失血量、水平衡、全身血管阻力指数以及氧分压与吸入氧分数之比（P/F比）等临床变量。根据重复双向方差分析，CPB前组的白细胞计数、中性粒细胞计数以及C反应蛋白水平显著更低，而血小板计数显著更高。在CPB期间，CPB前组的混合静脉血氧饱和度显著更高，乳酸水平更低。CPB前组术后谷丙转氨酶和血尿素氮水平显著低于对照组。CPB前组的P/F比显著高于对照组。CPB前组的液体负荷需求量显著更低。在小儿心脏直视手术中，CPB开始前给予西维来司他比开始时给予更有效地抑制了因CPB引起的炎症反应，这一效果得到了临床证据的证实。
