Nteliopoulos Georgios, Nikolakopoulou Zacharoula, Chow Bobby Hiu Nam, Corless Rebecca, Nguyen Bao, Dimarakis Ioannis
Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, UK.
Expert Rev Cardiovasc Ther. 2022 Nov;20(11):871-880. doi: 10.1080/14779072.2022.2149492. Epub 2022 Dec 1.
Cardiopulmonary bypass (CPB) is an integral component of cardiac surgery; however, one of its most critical complications is acute lung injury induced by multiple factors including systemic inflammatory response.
The objective of this review is to investigate the multiple factors that can lead to CPB-induced lung injury. These include contact of blood components with the artificial surface of the CPB circuit, local and systemic inflammatory response syndrome (SIRS), lung ischemia/re-perfusion injury, arrest of ventilation, and circulating endotoxins. We also focus on possible interventions to curtail the negative impact of CPB, such as off-pump surgery, impregnation of the circuit with less biologically active substances, leukocyte depletion filters and ultrafiltration, and pharmacological agents such as steroids and aprotinin.
Although many aspects of CPB are proposed to contribute to lung injury, its overall role is still not clear. Multiple interventions have been introduced to reduce the risk of pulmonary dysfunction, with many of these interventions having shown promising results, significantly attenuating inflammatory mediators and improving post-operative outcome. However, since lung injury is multifactorial and affected by inextricably linked components, multiple interventions tackling each of them is required.
体外循环（CPB）是心脏手术的一个重要组成部分；然而，其最关键的并发症之一是由包括全身炎症反应在内的多种因素引起的急性肺损伤。
本综述的目的是研究可导致CPB诱导性肺损伤的多种因素。这些因素包括血液成分与CPB回路人工表面的接触、局部和全身炎症反应综合征（SIRS）、肺缺血/再灌注损伤、通气停止以及循环内毒素。我们还关注为减少CPB负面影响而可能采取的干预措施，如非体外循环手术、用生物活性较低的物质浸渍回路、白细胞滤器和超滤，以及类固醇和抑肽酶等药物。
尽管有人提出CPB的许多方面都与肺损伤有关，但其总体作用仍不明确。已经引入了多种干预措施来降低肺功能障碍的风险，其中许多干预措施已显示出有希望的结果，显著减轻了炎症介质并改善了术后结果。然而，由于肺损伤是多因素的且受相互紧密联系的成分影响，因此需要针对每个因素采取多种干预措施。
