Watarida S, Mori A, Onoe M, Tabata R, Shiraishi S, Sugita T, Nojima T, Nakajima Y, Matsuno S
Second Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
J Thorac Cardiovasc Surg. 1994 Oct;108(4):620-5.
Levels of endogenous endotoxins have been reported to increase after cardiopulmonary bypass. Endotoxin levels have also been implicated in multiple organ failure and may contribute to the immunocompromised state seen after bypass. We evaluated the effects of pulsatile cardiopulmonary bypass circulation on endogenous endotoxin levels. The study population consisted of 15 consecutive adult patients who underwent cardiac operations with cardiopulmonary bypass. Pulsatile flow was used during aortic crossclamping in eight patients (group I) and nonpulsatile flow was used in the remaining seven patients (group II). Changes in blood endotoxin levels were monitored during aortic crossclamping, after release of the clamp, and after weaning from bypass. The blood endotoxin level at each stage was expressed as a percentage of the level at the beginning of bypass. Group I patients a significantly lower blood endotoxin percentage than group II (from 20 to 120 minutes after the initiation of aortic crossclamping). In group I, the blood endotoxin percentage was nearly constant during aortic crossclamping. After release of aortic crossclamping, group I also had a lower blood endotoxin percentage than group II. Endogenous endotoxin levels appear to increase in the presence of intestinal congestion and ischemia. Improvement in intestinal circulation by pulsatile cardiopulmonary bypass may prevent increases in endogenous endotoxin levels by reducing these factors.
据报道，体外循环后内源性内毒素水平会升高。内毒素水平还与多器官功能衰竭有关，可能导致体外循环后出现的免疫功能低下状态。我们评估了搏动性体外循环对内源性内毒素水平的影响。研究人群包括15例连续接受体外循环心脏手术的成年患者。8例患者（I组）在主动脉阻断期间使用搏动血流，其余7例患者（II组）使用非搏动血流。在主动脉阻断期间、阻断解除后以及体外循环撤机后监测血内毒素水平变化。每个阶段的血内毒素水平均表示为体外循环开始时水平的百分比。I组患者的血内毒素百分比显著低于II组（在主动脉阻断开始后20至120分钟）。在I组中，主动脉阻断期间血内毒素百分比几乎保持恒定。主动脉阻断解除后，I组的血内毒素百分比也低于II组。在存在肠道充血和缺血的情况下，内源性内毒素水平似乎会升高。搏动性体外循环改善肠道循环可能通过减少这些因素来防止内源性内毒素水平升高。
