Mukaida Hiroshi, Matsushita Satoshi, Inotani Takahiro, Nakamura Atsushi, Amano Atsushi
Department of Cardiovascular Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan.
J Artif Organs. 2018 Jun;21(2):188-195. doi: 10.1007/s10047-018-1025-6. Epub 2018 Feb 5.
Cardiopulmonary bypass (CPB) induces a complex inflammatory response involving an increase in inflammatory cytokines, called postperfusion syndrome. Previous studies demonstrated that adsorption of the serum cytokines can reduce acute inflammation and improve clinical outcomes. In this study, patients were placed on continuous renal replacement therapy (CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter immediately after the start of an open-heart surgery with CPB and throughout the postoperative course to prevent postperfusion syndrome. The aim of this study was to assess whether continuous CRRT using a PMMA filter (PMMA-CRRT) could affect cytokine expression and improve perioperative outcomes. We designed a randomized controlled trial, which included 19 consecutive adult patients on maintenance dialysis and 7 consecutive adult patients who were not on maintenance dialysis (NHD group). Patients on maintenance dialysis were randomly divided into two groups: Ten patients who received CRRT with a polysulfone membrane hemofilter (PS group) and nine patients who received CRRT with a PMMA membrane (PMMA group). Blood samples were collected from the radial or brachial artery at five different time points. Comparisons between the PS, PMMA, and NHD groups revealed a significant main effect of time on changes in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p < 0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery were significantly lower in the PMMA group than in the PS group, while other cytokines measured in this study were not significantly different. In addition, clinical outcomes were not significantly different between the groups. The continuous use of PMMA-CRRT throughout the perioperative period suppressed serum IL-6 and IL-8 concentrations, although there were no differences in clinical outcomes.
体外循环（CPB）会引发一种复杂的炎症反应，包括炎症细胞因子增加，即灌注后综合征。先前的研究表明，吸附血清细胞因子可减轻急性炎症并改善临床结局。在本研究中，患者在体外循环心脏直视手术开始后立即使用聚甲基丙烯酸甲酯（PMMA）膜血液滤过器进行连续性肾脏替代治疗（CRRT），并在术后全程进行，以预防灌注后综合征。本研究的目的是评估使用PMMA滤器的连续性CRRT（PMMA-CRRT）是否会影响细胞因子表达并改善围手术期结局。我们设计了一项随机对照试验，其中包括19例接受维持性透析的成年患者和7例未接受维持性透析的成年患者（非HD组）。接受维持性透析的患者被随机分为两组：10例接受聚砜膜血液滤过器进行CRRT的患者（PS组）和9例接受PMMA膜进行CRRT的患者（PMMA组）。在五个不同时间点从桡动脉或肱动脉采集血样。PS组、PMMA组和非HD组之间的比较显示，时间对血清IL-6和IL-8浓度变化有显著的主效应（p<0.01），且时间与组之间存在交互作用（p<0.05）。PMMA组术后血浆IL-6和IL-8水平显著低于PS组，而本研究中检测的其他细胞因子无显著差异。此外，各组之间的临床结局无显著差异。尽管临床结局无差异，但围手术期全程持续使用PMMA-CRRT可抑制血清IL-6和IL-8浓度。
