Ng R R G, Chew S T H, Liu W, Ong P, Caleb M G, Ti L K
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Anaesthesiology, Singapore General Hospital, Singapore Department of Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore.
Perfusion. 2015 Sep;30(6):487-94. doi: 10.1177/0267659114563779. Epub 2014 Dec 11.
We compared the systemic inflammatory response of the MCPB system to the CCPB system with cell salvage and phosphorylcholine-coated tubing amongst Asian patients undergoing coronary artery bypass grafting.
Seventy-eight patients were randomly assigned to the MCPB or the CCPB groups equally and followed up in a prospective, single-blinded, randomised, controlled trial. Levels of TNF-α, IL-6, CRP and LDH were measured peri-operatively.
The systemic inflammatory response was similar in both groups (TNF-α: p=0.222; IL-6: p=0.991; CRP: p=0.258). Only haemolysis was significantly higher in the CCPB group (LDH: p=0.011). The MCPB system was twice more expensive, but had a near 4-fold cost saving in tranfusions. Overall, the MCPB system cost 20% more than the modified CCPB system.
These results corroborate with studies that demonstrated the avoidance of cardiotomy suction rather than the MCPB system, itself, leads to an attenuated inflammatory response. The absence of obvious clinical benefit and the higher costs involved with the MCPB system would preclude its routine use.
我们比较了在接受冠状动脉搭桥术的亚洲患者中，使用细胞回收和磷酸胆碱涂层管道的改良离心泵体外循环（MCPB）系统与传统离心泵体外循环（CCPB）系统的全身炎症反应。
78例患者被随机均分为MCPB组或CCPB组，并在前瞻性、单盲、随机对照试验中进行随访。在围手术期测量肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）和乳酸脱氢酶（LDH）的水平。
两组的全身炎症反应相似（TNF-α：p = 0.222；IL-6：p = 0.991；CRP：p = 0.258）。只有CCPB组的溶血明显更高（LDH：p = 0.011）。MCPB系统价格贵两倍，但在输血方面节省近4倍的成本。总体而言，MCPB系统的成本比改良CCPB系统高20%。
这些结果与研究结果一致，即避免使用心内吸引而不是MCPB系统本身会导致炎症反应减弱。MCPB系统缺乏明显的临床益处且成本较高，因此不适合常规使用。
