Seghaye M C, Duchateau J, Grabitz R G, Nitsch G, Marcus C, Messmer B J, von Bernuth G
Department of Pediatric Cardiology, RWTH Aachen, Germany.
J Thorac Cardiovasc Surg. 1994 Jul;108(1):29-36.
In 13 neonates undergoing cardiac operations for congenital cardiac defects, complement, leukocytes, and leukocyte elastase were studied during and after cardiopulmonary bypass. All but two neonates received prostaglandin E1 before the operation. The C3d/C3 ratio rose significantly during cardiopulmonary bypass from 0.86 +/- 0.55 to 1.40 +/- 0.56 (mean +/- standard deviation; p < 0.0001). Abnormally elevated C5a levels (18.6 +/- 7.3 micrograms/L) were measured at the end of cardiopulmonary bypass. C4 was not overtly consumed during the procedure. Leukocytes fell from a preoperative value of 10.06 +/- 3.15 x 10(9)/L to 3.21 +/- 0.64 x 10(9)/L after beginning of cardiopulmonary bypass (p < 0.0001) and rose at the end of the procedure from 2.33 +/- 0.67 x 10(9)/L to 7.19 +/- 1.84 x 10(9)/L, after protamine administration (p < 0.0001). Neutrophils fell from a preoperative value of 5.14 +/- 1.18 x 10(9)/L to 1.46 +/- 0.35 x 10(9)/L after beginning of cardiopulmonary bypass and rose at the end of extracorporeal circulation from 1.00 +/- 0.31 x 10(9)/L to 4.10 +/- 1.18 x 10(9)/L, after protamine administration (p < 0.005). Elastase release occurred in all neonates during cardiopulmonary bypass and averaged 331.5 +/- 175.7 micrograms/L. Complement activation and leukocyte stimulation did not correlate with postoperative complications or outcome. This study demonstrates complement activation and leukocyte stimulation in neonates undergoing cardiac operation.
在13例因先天性心脏缺陷接受心脏手术的新生儿中，研究了体外循环期间及之后补体、白细胞和白细胞弹性蛋白酶的情况。除两名新生儿外，所有患儿在手术前均接受了前列腺素E1治疗。体外循环期间，C3d/C3比值从0.86±0.55显著升至1.40±0.56（均值±标准差；p<0.0001）。体外循环结束时，检测到C5a水平异常升高（18.6±7.3微克/升）。手术过程中C4未出现明显消耗。体外循环开始后，白细胞从术前的10.06±3.15×10⁹/L降至3.21±0.64×10⁹/L（p<0.0001），在注射鱼精蛋白后，手术结束时从2.33±0.67×10⁹/L升至7.19±1.84×10⁹/L（p<0.0001）。中性粒细胞在体外循环开始后从术前的5.14±1.18×10⁹/L降至1.46±0.35×10⁹/L，在体外循环结束时，注射鱼精蛋白后从1.00±0.31×10⁹/L升至4.10±1.18×10⁹/L（p<0.005）。所有新生儿在体外循环期间均出现弹性蛋白酶释放，平均为331.5±175.7微克/升。补体激活和白细胞刺激与术后并发症或预后无关。本研究证明了接受心脏手术的新生儿存在补体激活和白细胞刺激。
