Morioka K, Muraoka R, Chiba Y, Ihaya A, Kimura T, Noguti H, Uesaka T
Second Department of Surgery, Fukui Medical School, Japan.
J Thorac Cardiovasc Surg. 1996 Jan;111(1):45-54. doi: 10.1016/S0022-5223(96)70400-2.
This study was undertaken to assess the effects of leukocyte and platelet depletion on postoperative lung injury in 42 patients who underwent heart operations. Blood was serially sampled before, during, and after cardiopulmonary bypass, and leukocyte count, platelet count, and thromboxane B2 6-keto-PGF1 alpha, leukocyte elastase, thrombin-antithrombin III complex, and D-dimer levels were determined. Postoperative respiratory function was assessed based on analyses of oxygenation and carbon dioxide elimination. Leukocyte and platelet depletion was performed in 21 patients (experimental group) but not in another (control group). In the experimental group, leukocytes and platelets were removed continuously by means of the blood cell separator CS-3000, beginning immediately after the start of the operation and ending 1 hour after the release of aortic occlusion. Leukocyte elastase, thromboxane B2, ratio of thromboxane B2 to 6-keto-PGF1 alpha, thrombin-antithrombin III complex, and D-dimer were significantly lower in the experimental group than in the control group. Of the various indexes of oxygenation, arterial oxygen tension was significantly higher in the experimental group and the alveolar-arterial oxygen pressure difference and respiratory index were significantly lower in the experimental group. The positive end-expiratory pressure needed to achieve an appropriate arterial oxygen tension was significantly lower in the experimental group. The elimination of carbon dioxide was lower in the experimental group. Depletion of leukocytes and platelets reduced respiratory dysfunction after heart operations with cardiopulmonary bypass. It was particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of cardiopulmonary bypass was required.
本研究旨在评估白细胞和血小板去除对42例接受心脏手术患者术后肺损伤的影响。在体外循环前、中、后连续采集血液，测定白细胞计数、血小板计数、血栓素B2、6-酮-前列腺素F1α、白细胞弹性蛋白酶、凝血酶-抗凝血酶III复合物和D-二聚体水平。根据氧合和二氧化碳清除分析评估术后呼吸功能。21例患者（实验组）进行白细胞和血小板去除，另一组（对照组）未进行。在实验组，从手术开始后立即借助血细胞分离器CS-3000持续去除白细胞和血小板，直至主动脉阻断解除后1小时。实验组的白细胞弹性蛋白酶、血栓素B2、血栓素B2与6-酮-前列腺素F1α的比值、凝血酶-抗凝血酶III复合物和D-二聚体均显著低于对照组。在各项氧合指标中，实验组的动脉血氧分压显著较高，而肺泡-动脉氧分压差和呼吸指数显著较低。实验组达到适当动脉血氧分压所需的呼气末正压显著较低。实验组的二氧化碳清除较低。白细胞和血小板去除可减轻体外循环心脏手术后的呼吸功能障碍。这对术前氧合能力低的患者以及需要长时间体外循环的患者尤为有效。
