Quigley R L, Caplan M S, Perkins J A, Arentzon C E, Alexander J C, Kuehn B E, Hoff W J, Wallock M E
Department of Surgery, Northwestern University, Evanston Hospital, Illinois, USA.
Perfusion. 1995;10(1):27-31. doi: 10.1177/026765919501000106.
Endotoxin and cytokine inflammatory mediators comprise the afferent and efferent limbs of the 'acute phase response'. During cardiopulmonary bypass (CPB) there may be gut translocation of endotoxin and contact activation of lymphocytes. It has been hypothesized that the haemodynamic instability encountered following CPB is caused by the 'acute phase response'. In this study we attempted to quantify the acute phase response in patients undergoing open-heart surgery and determine the influence of these cytokines on perioperative morbidity. Four perioperative blood samples were drawn from 20 consecutive patients undergoing coronary artery bypass grafting (CABG). These samples were assayed for endotoxin and four cytokines. In all cases the cardiac index was maintained > 2.4 l/min/m2 during nonpulsatile normothermic bypass (37 degrees C) and > 1.8 l/min/m2 during nonpulsatile hypothermic bypass (28 degrees C), and the perfusion pressure > 60 mmHg. Endotoxin was not detected in any of the test samples despite positive nonpatient controls. Interleukin 6 (IL-6) and tumour necrosis factor (TNF) were not detected despite an assay sensitivity of 80 and 10 pg/ml, respectively. TNF was detectable with an assay sensitivity of 0.5 pg/ml although there were no significant differences within the group. Interleukin 1 (IL-1) was detected (range = 0.98 - 9.09 ng/ml) in patients and again there were no trends within the group. The platelet activating factor (PAF) values peaked at crossclamp release (1.3 ng/ml versus a baseline of 0.2 ng/ml); however, there was no significant difference within the study.
内毒素和细胞因子炎症介质构成了“急性期反应”的传入和传出环节。在体外循环（CPB）期间，可能会发生内毒素的肠道移位以及淋巴细胞的接触激活。据推测，CPB后出现的血流动力学不稳定是由“急性期反应”引起的。在本研究中，我们试图量化接受心脏直视手术患者的急性期反应，并确定这些细胞因子对围手术期发病率的影响。从20例连续接受冠状动脉旁路移植术（CABG）的患者中采集了4份围手术期血样。对这些样本进行内毒素和四种细胞因子检测。在所有病例中，在非搏动性常温旁路（37℃）期间心脏指数维持>2.4升/分钟/平方米，在非搏动性低温旁路（28℃）期间维持>1.8升/分钟/平方米，灌注压>60毫米汞柱。尽管非患者对照呈阳性，但在任何测试样本中均未检测到内毒素。尽管检测灵敏度分别为80和10皮克/毫升，但未检测到白细胞介素6（IL-6）和肿瘤坏死因子（TNF）。尽管组内无显著差异，但TNF在检测灵敏度为0.5皮克/毫升时可检测到。在患者中检测到白细胞介素1（IL-1）（范围=0.98 - 9.09纳克/毫升），组内同样没有趋势。血小板活化因子（PAF）值在松开血管夹时达到峰值（1.3纳克/毫升，而基线为0.2纳克/毫升）；然而，研究中无显著差异。
