O-Yurvati Albert H, Rodriguez Steven, Bell Glen, Kennedy Damon, Mallet Robert T
Departments of Surgery and Integrative Physiology, University of North Texas Health Science Center,3500 Camp Bowie Boulevard,Fort Worth,Texas 76107-2699, USA.
J Atr Fibrillation. 2008 Dec 1;1(4):104. doi: 10.4022/jafib.104. eCollection 2008 Dec.
Atrial fibrillation remains the leading postoperative complication following cardiopulmonary bypass. A randomized trial was undertaken to evaluate the effectiveness of leukocyte filtration and aprotinin, applied separately and in combination, on the incidence of post-operative atrial fibrillation. A secondary component of the study was the impact of these adjunct interventions on post-surgical renal and neurological dysfunction. A total of 1,220 patients undergoing primary isolated coronary artery bypass grafting were randomly assigned to one of four treatment groups. The control group (305 patients) received standard cardiopulmonary bypass with moderately hypothermic (34ºC) cardioplegic arrest. In the filtration group (310 patients) leukocyte reducing filters were incorporated into the bypass circuit and deployed strategically. The aprotinin group (285 patients) received full Hammersmith dose aprotinin. The combination therapy group (320 patients) received both aprotinin and leukocyte filtration. The incidences of atrial fibrillation were 25% in the control group, 16% in the filtration group, 19% in the aprotinin group and 10% in the combination therapy group (P < 0.001). Renal dysfunction was detected in 3% of the control group, 2% of the filtration group, 8% of the aprotinin group, and 5% of the combination group (P < 0.005). Neurological dysfunction occurred in 2% of the control group, 2% of the filtration group, 1% of the aprotinin group, and 2% of the combination group (P = n.s.). Combination therapy with aprotinin and leukocyte filtration markedly reduced atrial fibrillation post-cardiopulmonary bypass, and was more effective than the individual treatments. Aprotinin treatment increased the incidence of renal dysfunction, and the addition of leukocyte filtration partially mitigated this detrimental effect of aprotinin. Thus, strategic leukocyte filtration augments aprotinin's anti-arrhythmic effects while suppressing its nephrotoxic sequelae.
心房颤动仍然是体外循环术后的主要并发症。开展了一项随机试验，以评估单独及联合应用白细胞滤过和抑肽酶对术后心房颤动发生率的影响。该研究的次要内容是这些辅助干预措施对术后肾脏和神经功能障碍的影响。共有1220例行初次单纯冠状动脉搭桥术的患者被随机分配至四个治疗组之一。对照组（305例患者）接受标准体外循环及中度低温（34℃）心脏停搏。滤过组（310例患者）在体外循环回路中加入白细胞滤器并进行策略性部署。抑肽酶组（285例患者）接受全量哈默史密斯剂量的抑肽酶。联合治疗组（320例患者）接受抑肽酶和白细胞滤过治疗。对照组心房颤动发生率为25%，滤过组为16%，抑肽酶组为19%，联合治疗组为10%（P<0.001）。对照组3%、滤过组2%、抑肽酶组8%、联合组5%出现肾功能障碍（P<0.005）。对照组2%、滤过组2%、抑肽酶组1%、联合组2%发生神经功能障碍（P=无统计学意义）。抑肽酶和白细胞滤过联合治疗显著降低了体外循环术后心房颤动的发生率，且比单独治疗更有效。抑肽酶治疗增加了肾功能障碍的发生率，而加入白细胞滤过可部分减轻抑肽酶的这种有害作用。因此，策略性白细胞滤过增强了抑肽酶的抗心律失常作用，同时抑制了其肾毒性后遗症。
