Jansen P G, Te Velthuis H, Oudemans-Van Straaten H M, Bulder E R, Van Deventer S J, Sturk A, Eijsman L, Wildevuur C R
Department of Cardiac Surgery, Free University Hospital, Amsterdam, The Netherlands.
Eur J Cardiothorac Surg. 1994;8(3):125-9. doi: 10.1016/1010-7940(94)90167-8.
To investigate whether the release of endotoxin during cardiopulmonary bypass (CPB) is determined by perfusion-related factors, endotoxin concentrations were determined before, during, and after CPB in 21 male patients (age range 45-75 years) undergoing elective coronary artery bypass grafting. Hemodynamic parameters and oncotic pressure were also measured. Significant increases in endotoxin concentrations were observed after the start of CPB (P < 0.005), before aortic cross-clamp release (P < 0.05), and after aortic cross-clamp release (P < 0.05). The median endotoxin concentration after cessation of CPB was 0.264 EU/ml (range < 0.036-0.480 EU/ml). Endotoxin concentrations derived from the prime solutions were not contributory. Positive correlations were found between arterial pressure after the start of CPB and the endotoxin concentration 10 min after (r = 0.58, P < 0.01) and between the duration of aortic cross-clamping and the endotoxin concentration after the cessation of CPB (r = 0.64, P < 0.005). Arterial pressure after the start of CPB, the duration of aortic cross-clamping, and decrease in oncotic pressure appeared to be independent variables in a forward variable selection model that predicted endotoxin concentrations after CPB. We conclude that in patients undergoing elective coronary artery bypass grafting, an early phase of endotoxin release during CPB could be demonstrated, and that this is due to vasoconstriction. The endotoxin concentrations after the cessation of CPB were determined by early vasoconstriction, duration of aortic cross-clamping, and hypo-oncotic hemodilution.
为了研究体外循环（CPB）期间内毒素的释放是否由灌注相关因素决定，我们对21例年龄在45至75岁之间接受择期冠状动脉搭桥术的男性患者，在CPB前、期间和之后测定了内毒素浓度。同时还测量了血流动力学参数和胶体渗透压。在CPB开始后（P < 0.005）、主动脉阻断钳松开前（P < 0.05）以及主动脉阻断钳松开后（P < 0.05），均观察到内毒素浓度显著升高。CPB停止后的内毒素浓度中位数为0.264 EU/ml（范围< 0.036 - 0.480 EU/ml）。预充液中的内毒素浓度并无影响。发现CPB开始后的动脉压与10分钟后的内毒素浓度之间存在正相关（r = 0.58，P < 0.01），以及主动脉阻断时间与CPB停止后的内毒素浓度之间存在正相关（r = 0.64，P < 0.005）。在预测CPB后内毒素浓度的向前变量选择模型中，CPB开始后的动脉压、主动脉阻断时间和胶体渗透压降低似乎是独立变量。我们得出结论，在接受择期冠状动脉搭桥术的患者中，可以证明CPB期间存在内毒素释放的早期阶段，这是由于血管收缩所致。CPB停止后的内毒素浓度由早期血管收缩、主动脉阻断时间和低胶体渗透压血液稀释所决定。
