Bauer Adrian, Hausmann Harald, Schaarschmidt Jan, Scharpenberg Martin, Troitzsch Dirk, Johansen Peter, Nygaard Hans, Eberle Thomas, Hasenkam J Michael
1 MediClin Heart Centre Coswig, Department of Cardiovascular Perfusion, Coswig, Saxony-Anhalt, Germany.
2 MediClin Heart Centre Coswig, Department of Anaesthesia and Intensive Care Medicine Coswig, Saxony-Anhalt, Germany.
Perfusion. 2018 Mar;33(2):136-147. doi: 10.1177/0267659117728195. Epub 2017 Sep 22.
The postoperative systemic inflammatory response after cardiopulmonary bypass (CPB) is still an undesirable side-effect after cardiac surgery. It is most likely caused by blood contact with foreign surfaces and by the surgical trauma itself. However, the recirculation of activated shed mediastinal blood is another main cause of blood cell activation and cytokine release. Minimal invasive extracorporeal circulation (MiECC) comprises a completely closed circuit, coated surfaces and the separation of suction blood. We hypothesized that MiECC, with separated cell saved blood, would induce less of a systemic inflammatory response than MiECC with no cell-saver. The aim of this study was, therefore, to investigate the impact of cell washing shed blood from the operating field versus direct return to the ECC on the biomarkers for systemic inflammation.
In the study, patients with MiECC and cell-saver were compared with the control group, patients with MiECC and direct re-transfusion of the drawn blood shed from the surgical field.
High amounts of TNF-α (+ 120% compared to serum blood) were found in the shed blood itself, but a significant reduction was demonstrated with the use of a cell-saver (TNF-α ng/l post-ECC 10 min: 9.5±3.5 vs. 19.7±14.5, p<0.0001). The values for procalcitonin were not significantly increased in the control group (6h: 1.07±3.4 vs. 2.15±9.55, p=0.19) and lower for C-reactive protein (CRP) (24h: 147.1±64.0 vs.134.4±52.4 p=0.28).
The use of a cell-saver and the processing of shed blood as an integral part of MiECC significantly reduces the systemic cytokine load. We, therefore, recommend the integration of cell-saving devices in MiECC to reduce the perioperative inflammatory response.
体外循环（CPB）后的术后全身炎症反应仍是心脏手术后不良的副作用。这很可能是由于血液与异物表面接触以及手术创伤本身所致。然而，活化的纵隔引流血再循环是血细胞活化和细胞因子释放的另一个主要原因。微创体外循环（MiECC）包括一个完全封闭的回路、涂层表面和吸引血的分离。我们假设，与不使用血液回收机的MiECC相比，使用分离出的回收血细胞的MiECC会引发更少的全身炎症反应。因此，本研究的目的是调查将术野冲洗回收血与直接回输至体外循环相比，对全身炎症生物标志物的影响。
在本研究中，将使用MiECC和血液回收机的患者与对照组（使用MiECC并直接回输术野引流血的患者）进行比较。
在引流血中发现大量肿瘤坏死因子-α（TNF-α）（与血清血相比增加120%），但使用血液回收机后显著降低（体外循环后10分钟TNF-α ng/l：9.5±3.5 vs. 19.7±14.5，p<0.0001）。对照组降钙素原的值没有显著升高（6小时：1.07±3.4 vs. 2.15±9.55，p=0.19），C反应蛋白（CRP）的值更低（24小时：147.1±64.0 vs.134.4±52.4，p=0.28）。
使用血液回收机并将引流血处理作为MiECC不可或缺的一部分，可显著降低全身细胞因子负荷。因此，我们建议在MiECC中整合血液回收装置，以减少围手术期的炎症反应。
