体外循环诱导的炎症反应：病理生理学与治疗

Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment.

作者信息

Bronicki Ronald A, Hall Mark

机构信息

1Department of Pediatrics, Section of Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 2Department of Pediatrics, Section of Critical Care Medicine, Ohio State College of Medicine, Nationwide Children's Hospital, Columbus, OH.

出版信息

Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S272-8. doi: 10.1097/PCC.0000000000000759.

DOI:10.1097/PCC.0000000000000759

PMID:27490610

Abstract

OBJECTIVES

The objectives of this review are to discuss the pathophysiology of the pro-inflammatory response to the cardiopulmonary bypass circuit, the impact of ischemia reperfusion injury on post-operative organ function, the compensatory anti-inflammatory response and the evidence for immune-modulatory strategies and their impact on outcomes.

DATA SOURCE

MEDLINE, PubMed.

CONCLUSION

Innovations such as the development of more biocompatible surfaces and miniaturized circuits, as well as the increasing expertise of surgeons, anesthesiologists and perfusionists has transformed cardiac surgery and the use of cardiopulmonary bypass into a relatively routine procedure with favorable outcomes. Despite these refinements, the attendant inflammatory response to bypass, ischemia reperfusion injury and the compensatory anti-inflammatory response contribute to post-operative morbidity and mortality. Additional studies are needed to further delineate the impact of immunomodulatory strategies on outcomes.

摘要

目的

本综述的目的是讨论对体外循环回路促炎反应的病理生理学、缺血再灌注损伤对术后器官功能的影响、代偿性抗炎反应以及免疫调节策略的证据及其对结局的影响。

数据来源

医学在线数据库、医学期刊数据库。

结论

诸如开发更具生物相容性的表面和小型化回路等创新，以及外科医生、麻醉师和灌注师专业知识的不断提高，已经将心脏手术和体外循环的使用转变为一种相对常规的手术，且预后良好。尽管有这些改进，但体外循环伴随的炎症反应、缺血再灌注损伤和代偿性抗炎反应仍会导致术后发病和死亡。需要进一步的研究来进一步阐明免疫调节策略对结局的影响。