Giacinto Omar, Satriano Umberto, Nenna Antonio, Spadaccio Cristiano, Lusini Mario, Mastroianni Ciro, Nappi Francesco, Chello Massimo
Department of Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy.
Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
Recent Pat Inflamm Allergy Drug Discov. 2019;13(2):158-173. doi: 10.2174/1872213X13666190724112644.
Endothelial injury occurring during cardiopulmonary bypass is a major contributing factor in the development of organ dysfunction, which leads to many of the postoperative complications occurring during cardiac surgery.
This narrative review aims to summarize the main mechanisms of cardiopulmonary bypass - related disease, evaluating the unfavorable events leading to tissue injury, with a description of current pharmacologic and non-pharmacologic mechanisms to reduce CPB-related injury.
A Medline/Pubmed/Scopus search was conducted using clinical queries with the key terms "cardiac surgery", "cardiopulmonary bypass", "inflammation" and "endothelial injury", and related MeSH terms, until July 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the same key terms from https://patents.google.com/, www.uspto.gov, and www.freepatentsonline.com.
In this review, we discuss the current knowledge of the mechanisms of vascular endothelial cell injury, the acute inflammatory response, and the regulatory factors that control the extent of vascular injury during extracorporeal circulation, summarizing the main target of anti-inflammatory pharmacologic and non-pharmacologic strategies.
Inflammatory response and endothelial dysfunction following cardiopulmonary bypass are the prices to pay for the benefits offered during cardiac surgery procedures. Counteracting the detrimental effect of extracorporeal circulation appears to be crucial to improve clinical outcomes in pediatric and adult cardiac surgery. The intrinsic complexity and the tight interplay of the factors involved might require a holistic approach against inflammation and endothelial response.
体外循环期间发生的内皮损伤是器官功能障碍发展的主要促成因素，这会导致心脏手术期间出现许多术后并发症。
本叙述性综述旨在总结体外循环相关疾病的主要机制，评估导致组织损伤的不良事件，并描述当前减少体外循环相关损伤的药理学和非药理学机制。
截至2019年7月，使用临床查询在Medline/Pubmed/Scopus数据库中进行检索，关键词为“心脏手术”“体外循环”“炎症”和“内皮损伤”以及相关医学主题词。检索策略包括荟萃分析、随机对照试验、临床试验、综述及相关参考文献。使用来自https://patents.google.com/、www.uspto.gov和www.freepatentsonline.com的相同关键词检索专利。
在本综述中，我们讨论了血管内皮细胞损伤机制、急性炎症反应以及体外循环期间控制血管损伤程度的调节因子的现有知识，总结了抗炎药理学和非药理学策略的主要靶点。
体外循环后的炎症反应和内皮功能障碍是心脏手术过程中所获益处的代价。抵消体外循环的有害影响对于改善小儿和成人心脏手术的临床结局似乎至关重要。所涉及因素的内在复杂性和紧密相互作用可能需要针对炎症和内皮反应采取整体方法。
