Kirklin J K, Westaby S, Blackstone E H, Kirklin J W, Chenoweth D E, Pacifico A D
J Thorac Cardiovasc Surg. 1983 Dec;86(6):845-57.
Postoperative cardiac, pulmonary, renal and coagulation dysfunction, along with C3a levels, were studied prospectively in 116 consecutive patients undergoing open cardiac operations and 12 patients undergoing closed operations in the same time period. The level of C3a 3 hours after open operation was high (median value 882 ng X ml-1 plasma) and was related to the C3a level before cardiopulmonary bypass (CPB) (p = 0.03), the level at the end of CPB (p less than 0.0001), elapsed time of CPB (p = 0.07), and older age at operation (p less than 0.0001). It was inversely related to the cardiac output as reflected by the strength of the pedal pulses (p = 0.006). In contrast, C3a levels did not rise in patients undergoing closed operations. The probability of postoperative cardiac dysfunction after open operations (present in 27 of 116 patients) was predicted by C3a levels 3 hours after operation (p = 0.02), the CPB time (p = 0.02), and younger age (p less than 0.0001). The same risk factors pertained for postoperative pulmonary dysfunction (present in 41 of the 116 patients); renal dysfunction (present in 24 of the 116 patients) except that CPB time was not a risk factor here; abnormal bleeding (present in 21 of the 116 patients); and important overall morbidity (present in 26 of 116 patients). As regards important overall morbidity, the C3a level effect became evident at about 1,900 ng X ml-1 (a level reached by 9% of patients); the effect of increasing time of CPB became evident at about 90 minutes of CPB time; and the effect of young age became evident as age decreased from 10 to 4 years. This study demonstrates the damaging effects of CPB, relates them in part to complement activation by the foreign surfaces encountered by the blood, and supports the hypothesis that the mechanisms of the damaging effects include a whole-body inflammatory reaction.
前瞻性研究了116例连续接受心脏直视手术的患者以及同期12例接受闭式手术的患者术后的心脏、肺、肾和凝血功能障碍，以及C3a水平。心脏直视手术后3小时C3a水平较高（血浆中位数为882 ng×ml-1），且与体外循环（CPB）前的C3a水平相关（p = 0.03）、CPB结束时的水平相关（p<0.0001）、CPB持续时间相关（p = 0.07）以及手术时年龄较大相关（p<0.0001）。它与通过足背动脉搏动强度反映的心输出量呈负相关（p = 0.006）。相比之下，接受闭式手术的患者C3a水平未升高。心脏直视手术后发生心脏功能障碍（116例患者中有27例出现）的概率可通过术后3小时的C3a水平（p = 0.02）、CPB时间（p = 0.02）以及年龄较小（p<0.0001）来预测。同样的危险因素适用于术后肺功能障碍（116例患者中有41例出现）；肾功能障碍（116例患者中有24例出现），不过在此CPB时间不是危险因素；异常出血（116例患者中有21例出现）；以及严重的总体并发症（116例患者中有26例出现）。关于严重的总体并发症，C3a水平的影响在约1900 ng×ml-1时变得明显（9%的患者达到该水平）；CPB时间延长的影响在CPB时间约90分钟时变得明显；年龄较小的影响在年龄从10岁降至4岁时变得明显。本研究证明了CPB的损害作用，部分将其与血液接触异物表面引发的补体激活相关联，并支持了损害作用机制包括全身炎症反应的假说。
