Tönz M, Mihaljevic T, von Segesser L K, Fehr J, Schmid E R, Turina M I
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
Chest. 1995 Dec;108(6):1551-6. doi: 10.1378/chest.108.6.1551.
To test the hypothesis that acute lung injury during cardiopulmonary bypass (CPB) is related to the activation of neutrophils and the body temperature during bypass, we determined the differential WBC count, plasma elastase concentrations, and lung function before, during, and after CPB in 38 patients undergoing elective coronary artery bypass surgery. The patients were randomly assigned to receive either normothermic (n = 19, rectal temperature: 35.9 +/- 0.1 degrees C, mean +/- SE) or hypothermic (n = 19, 29.2 +/- 0.5 degrees C) CPB. The cellular response to the extracorporeal circulation was significantly delayed in the hypothermic group with a later onset of neutrophilia and a later increase in plasma elastase levels during bypass. Lung function deteriorated significantly after CPB as assessed by respiratory index, alveolar-arterial oxygen gradient, and intrapulmonary shunt, independent of bypass temperature. There was a positive correlation between peak elastase concentrations and postoperative respiratory index as well as intrapulmonary shunt (R2 = 0.5, p = 0.002 and R2 = 0.45, p = 0.003, respectively). Besides peak plasma elastase levels, multiple regression revealed no significant influence of other independent factors on postoperative lung dysfunction in our patients.
为验证体外循环（CPB）期间急性肺损伤与中性粒细胞活化及体外循环期间体温有关这一假说，我们测定了38例行择期冠状动脉搭桥手术患者在CPB前、期间及之后的白细胞分类计数、血浆弹性蛋白酶浓度及肺功能。患者被随机分为接受正常体温（n = 19，直肠温度：35.9±0.1℃，均值±标准误）或低温（n = 19，29.2±0.5℃）CPB两组。低温组对体外循环的细胞反应显著延迟，中性粒细胞增多症出现较晚，体外循环期间血浆弹性蛋白酶水平升高也较晚。根据呼吸指数、肺泡-动脉氧梯度及肺内分流评估，CPB后肺功能显著恶化，且与体外循环温度无关。弹性蛋白酶峰值浓度与术后呼吸指数及肺内分流呈正相关（分别为R2 = 0.5，p = 0.002和R2 = 0.45，p = 0.003）。除血浆弹性蛋白酶峰值水平外，多元回归显示其他独立因素对我们患者术后肺功能障碍无显著影响。
