含血心肺转流预充液会加速小儿心脏手术期间的炎症反应。

Sanguineous cardiopulmonary bypass prime accelerates the inflammatory response during pediatric cardiac surgery.

作者信息

Bierer Joel, Stanzel Roger, Henderson Mark, Sapp John, Andreou Pantelis, Marshall Jean S, Horne David

机构信息

Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada.

Department of Clinical Perfusion, Nova Scotia Health Authority, Halifax, NS, Canada.

出版信息

Perfusion. 2024 Oct 9:2676591241291944. doi: 10.1177/02676591241291944.

DOI:10.1177/02676591241291944

PMID:39383445

Abstract

BACKGROUND

The inflammatory response to cardiopulmonary bypass (CPB) in pediatric patients remains an unresolved challenge. Sanguineous CPB prime, composed of allogenic blood products, is one potentially important stimulus. This study aims to identify specific inflammatory mediators active in sanguineous CPB prime and their impact on the inflammatory response at CPB initiation.

METHODS

In a post-hoc analysis of a prospective observational cohort study (NCT05154864), where pediatric patients undergoing cardiac surgery with CPB were enrolled after informed consent, patients were grouped by CPB prime type ( vs ). Arterial samples were collected post-sternotomy as a baseline and again at CPB initiation from all patients. In the group, CPB prime samples were also collected after buffered ultrafiltration but before CPB initiation. measured concentrations of 24 inflammatory mediators for comparison between groups. Statistical analyses were by Mann-Whitney test and Wilcoxon signed-rank test. Data are presented as median [IQR].

RESULTS

Forty consecutive pediatric patients participated. The group ( = 26) was younger (4.0 [0.2 - 6.0] vs 48.5 [39.0 - 69.5] months; = 2.6 × 10) and smaller (4.9 [34 - 6.6] vs 17.2 [14.9 - 19.6] kg; = 2.6 × 10) than the group ( = 14). Despite this, baseline concentrations of 20 complement and cytokine concentrations were comparable between groups ( > 0.05) while four showed differences between groups ( < 0.05). The sanguineous prime contained supraphysiologic concentrations of complement mediators: C2, C3, C3a, C3b, and C5a. Correspondingly, upon CPB initiation, patients receiving sanguineous prime exhibited a significantly larger burden of C2, C3, C3b, C5, and C5a ( < 0.001) relative to the crystalloid group. Cytokine and chemokine mediators were present at trace levels in the sanguineous prime.

CONCLUSIONS

Sanguineous prime contains activated complement that accelerates the inflammatory response at CPB initiation in neonates and infants. Immunomodulatory interventions targeting complement during CPB prime preparation could offer substantial benefits for these vulnerable patients.

摘要

背景

小儿患者对体外循环（CPB）的炎症反应仍然是一个尚未解决的挑战。由同种异体血液制品组成的含血CPB预充液是一个潜在的重要刺激因素。本研究旨在确定在含血CPB预充液中起作用的特定炎症介质及其对CPB开始时炎症反应的影响。

方法

在一项前瞻性观察队列研究（NCT05154864）的事后分析中，纳入了在获得知情同意后接受CPB心脏手术的小儿患者，根据CPB预充液类型对患者进行分组（与）。所有患者在胸骨切开术后采集动脉样本作为基线，并在CPB开始时再次采集。在组中，还在缓冲超滤后但在CPB开始前采集CPB预充液样本。测量了24种炎症介质的浓度以进行组间比较。统计分析采用Mann-Whitney检验和Wilcoxon符号秩检验。数据以中位数[四分位间距]表示。

结果

连续40例小儿患者参与研究。组（ = 26）比组（ = 14）年龄更小（4.0[0.2 - 6.0]个月对48.5[39.0 - 69.5]个月； = 2.6×10）且体重更轻（4.9[3.4 - 6.6]千克对17.2[14.9 - 19.6]千克； = 2.6×10）。尽管如此，两组之间20种补体和细胞因子浓度的基线水平相当（ > 0.05），而有4种显示出组间差异（ < 0.05）。含血预充液中补体介质的浓度高于生理水平：C2、C3、C3a、C3b和C5a。相应地，在CPB开始时，接受含血预充液的患者相对于晶体液组表现出C2、C3、C3b、C5和C5a的负担显著更大（ < 0.001）。细胞因子和趋化因子介质在含血预充液中的含量极低。