Ovrum E, Mollnes T E, Fosse E, Holen E A, Tangen G, Abdelnoor M, Ringdal M A, Oystese R, Venge P
Department of Cardiac Surgery and Anesthesiology, Oslo Heart Center, Norway.
J Thorac Cardiovasc Surg. 1995 Dec;110(6):1623-32. doi: 10.1016/s0022-5223(95)70023-4.
Complement and granulocyte activation were studied in cardiopulmonary bypass circuits completely coated with either end-attached covalent-bonded heparin, the Carmeda BioActive Surface, or with the Duraflo II bonded heparin, in combination with reduced systemic heparinization (activated clotting time > 250 seconds). The control groups were perfused with uncoated circuits and full heparin dose (activated clotting time > 480 seconds). Altogether 67 patients undergoing elective first-time myocardial revascularization were investigated, having extracorporeal perfusion with a Duraflo II coated circuit (n = 17), an identical but uncoated circuit (n = 17), a Carmeda coated circuit (n = 17), or an equivalent uncoated circuit (n = 16). During cardiopulmonary bypass, the C3 activation products C3b, iC3b, and C3c (C3bc) and the terminal SC5b-9 complemented complex increased markedly in all four groups compared with baseline, but significantly less in the two coated groups than in their control groups. Additionally, a significantly lower concentration of C3bc was observed in the Carmeda coated group, with maximal increase of median 28 AU/ml compared with 50 AU/ml in the Duraflo II coated group (p = 0.003). Similarly, in the Carmeda coated group, the maximal increase of terminal complement complex was considerably lower (0.8 AU/ml) than the levels recognized in the Duraflo II coated group (2.4 AU/ml) (p < 0.001). The release of the granulocyte activation myeloperoxidase and lactoferrin increased from the beginning of the operation, with peak levels at the end of bypass. A significant reduction of lactoferrin release was recognized when comparing the coated groups with the control groups. The difference between the two coated groups (Carmeda 228 micrograms/L; Duraflo II 332 micrograms/L; p = 0.05) was marginally significant. For myeloperoxidase, no significant differences were observed between the coated and uncoated groups. In conclusion, both types of heparin-coated circuits reduced complement activation and release of lactoferrin, but the Carmeda circuit proved to be more effective than the Duraflo II equipment.
在完全涂覆有末端连接的共价键合肝素（卡美达生物活性表面）或杜拉弗洛II型键合肝素的体外循环回路中，结合降低全身肝素化水平（活化凝血时间>250秒），研究补体和粒细胞激活情况。对照组采用未涂覆的回路和全剂量肝素（活化凝血时间>480秒）进行灌注。共对67例择期首次心肌血运重建患者进行了研究，这些患者体外循环时分别使用杜拉弗洛II型涂覆回路（n = 17）、相同但未涂覆的回路（n = 17）、卡美达涂覆回路（n = 17）或等效的未涂覆回路（n = 16）。在体外循环期间，与基线相比，所有四组中补体C3激活产物C3b、iC3b和C3c（C3bc）以及末端SC5b - 9补体复合物均显著增加，但两个涂覆组的增加幅度明显小于其对照组。此外，在卡美达涂覆组中观察到C3bc浓度显著较低，中位数最大增加28 AU/ml，而杜拉弗洛II型涂覆组为50 AU/ml（p = 0.003）。同样，在卡美达涂覆组中，末端补体复合物的最大增加量（0.8 AU/ml）明显低于杜拉弗洛II型涂覆组（2.4 AU/ml）（p < 0.001）。粒细胞激活产物髓过氧化物酶和乳铁蛋白的释放从手术开始时就增加，在体外循环结束时达到峰值水平。与对照组相比，涂覆组乳铁蛋白释放量显著降低。两个涂覆组之间的差异（卡美达228微克/升；杜拉弗洛II型332微克/升；p = 0.05）具有边缘显著性。对于髓过氧化物酶，涂覆组和未涂覆组之间未观察到显著差异。总之，两种类型的肝素涂覆回路均降低了补体激活和乳铁蛋白的释放，但卡美达回路比杜拉弗洛II型设备更有效。
