Deng M C, Dasch B, Erren M, Möllhoff T, Scheld H H
Department of Thoracic and Cardiovascular Surgery, Muenster University Hospital, Germany.
Ann Thorac Surg. 1996 Jul;62(1):184-90. doi: 10.1016/0003-4975(96)00230-5.
Although patients with reduced left ventricular ejection fraction undergoing cardiac operation experience a higher rate of perioperative complications, the contribution of proinflammatory cytokines released during extracorporeal circulation is not well defined.
We compared arterial and mixed venous levels of interleukin-6, tumor necrosis factor-alpha, soluble interleukin-2 receptor, and interleukin-2 at 10 points in time (24 hours before until 48 hours after extracorporeal circulation) in 21 patients with an ejection fraction of less than 0.45 (study group) to 15 patients with an ejection fraction of more than 0.55 (control group) undergoing elective coronary artery bypass grafting. The study and control group differed with regard to left ventricular ejection fraction (0.37 +/- 0.05 versus 0.66 +/- 0.11, p < 0.05) and reperfusion time (35 +/- 42 minutes versus 18 +/- 4 minutes, p = 0.07), but not age, sex, vessel involvement, number of grafts performed, cross-clamp time, extracorporeal circulation time, core temperature, and duration of ventilation.
Six patients in the study group required mechanical support and 1 died. There were no complications in the control group. In the study group, there were higher preoperative interleukin-2 and tumor necrosis factor-alpha levels and a higher maximum cytokine response to extracorporeal circulation for interleukin-2, soluble interleukin-2 receptor, interleukin-6, and tumor necrosis factor-alpha (all p < 0.05). Interleukin-6 correlated with duration of extracorporeal circulation, dose of norepinephrine and epinephrine support, pulmonary capillary wedge pressure, mean pulmonary arterial pressure, right atrial pressure, heart rate, cardiac index, and inversely with systemic vascular resistance. Interleukin-6 was highest in patients with complications. Arterial and venous cytokine levels correlated closely.
Preoperative left ventricular dysfunction is associated with a higher degree of proinflammatory cytokine release during elective coronary artery bypass grafting. This response is associated with impaired hemodynamics and a higher incidence of perioperative complications.
尽管左心室射血分数降低的患者在接受心脏手术时围手术期并发症发生率较高，但体外循环期间释放的促炎细胞因子的作用尚不明确。
我们比较了21例射血分数小于0.45的患者（研究组）和15例射血分数大于0.55的患者（对照组）在10个时间点（体外循环前24小时至体外循环后48小时）的动脉血和混合静脉血中白细胞介素-6、肿瘤坏死因子-α、可溶性白细胞介素-2受体和白细胞介素-2的水平。研究组和对照组在左心室射血分数（0.37±0.05对0.66±0.11，p<0.05）和再灌注时间（35±42分钟对18±4分钟，p = 0.07）方面存在差异，但在年龄、性别、血管受累情况、进行的移植血管数量、主动脉阻断时间、体外循环时间、核心温度和通气时间方面无差异。
研究组有6例患者需要机械支持，1例死亡。对照组无并发症。在研究组中，术前白细胞介素-2和肿瘤坏死因子-α水平较高，白细胞介素-2、可溶性白细胞介素-2受体、白细胞介素-6和肿瘤坏死因子-α对体外循环的最大细胞因子反应较高（均p<0.05）。白细胞介素-6与体外循环时间、去甲肾上腺素和肾上腺素支持剂量、肺毛细血管楔压、平均肺动脉压、右心房压、心率、心脏指数呈正相关，与体循环血管阻力呈负相关。白细胞介素-6在有并发症的患者中最高。动脉血和静脉血中的细胞因子水平密切相关。
术前左心室功能障碍与择期冠状动脉搭桥手术期间促炎细胞因子释放程度较高有关。这种反应与血流动力学受损和围手术期并发症发生率较高有关。
