Saatvedt K, Lindberg H, Geiran O R, Michelsen S, Pedersen T, Seem E, Mollnes T E
Department of Cardiovascular Surgery, Rikshospitalet, University of Oslo, Norway.
Cardiovasc Res. 1996 Apr;31(4):596-602.
The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children.
Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring.
Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively.
In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.
本研究旨在评估术中体外超滤（UF）的临床和血流动力学效果，以及其在降低儿童心脏直视手术后循环细胞因子血浆浓度和补体激活产物方面的潜力。
18例先天性心脏病患儿被前瞻性随机分为对照组（n = 9）和接受超滤的组（n = 9）。在体外循环（CPB）前、期间及术后48小时内，采集系列血浆样本，用于检测循环细胞因子（白细胞介素6（IL-6）、肿瘤坏死因子α（TNF）及其可溶性受体（sTNF受体））和补体因子（C3激活产物（C3a和C3bc）以及末端补体复合物（TCC））。术前插入肺动脉热稀释导管进行血流动力学监测。
两组术后血流动力学相似。两组围手术期血浆IL-6、sTNF受体、C3a、C3bc和TCC水平均显著升高（P < 0.01）。16例患者围手术期短暂检测到TNF，9份超滤样本中的4份检测到的浓度与血浆水平相似。除2例检测到少量C3a外，超滤样本中未检测到补体激活产物。与对照组相比，超滤过程未影响C3a、C3bc和TCC的血浆水平。超滤15分钟后，IL-6和sTNF受体水平显著升高，但两组术后无显著差异。
在本研究中，超滤后未观察到临床或血流动力学效果。超滤液中偶尔检测到TNF和C3a，但我们未能证明超滤组中这些或其他任何检测标志物有所降低。
