Gu Y J, de Vries A J, Boonstra P W, van Oeveren W
Department of Cardiothoracic Surgery, University Hospital, Groningen, The Netherlands.
J Thorac Cardiovasc Surg. 1996 Aug;112(2):494-500. doi: 10.1016/s0022-5223(96)70277-5.
Leukocyte depletion during cardiopulmonary bypass has been demonstrated in animal experiments to improve pulmonary function. Conflicting results have been reported, however, with clinical depletion by arterial line filter of leukocytes at the beginning of cardiopulmonary bypass. In this study, we examined whether leukocyte depletion from the residual heart-lung machine blood at the end of cardiopulmonary bypass would improve lung function and reduce the postoperative inflammatory response. Thirty patients undergoing elective heart operations were randomly allocated to a leukocyte-depletion group or a control group. In the leukocyte-depletion group (n = 20), all residual blood (1.2 to 2.1 L) was filtered by leukocyte-removal filters and reinfused after cardiopulmonary bypass, whereas in the control group an identical amount of residual blood after cardiopulmonary bypass was reinfused without filtration (n = 10). Leukocyte depletion removed more than 97% of leukocytes from the retransfused blood (p < 0.01) and significantly reduced circulating leukocytes (p < 0.05) and granulocytes (p < 0.05) compared with the control group. Levels of the inflammatory mediator thromboxane B2 determined at the end of operation (p < 0.05) were significantly lower in the depletion group than in the control group, whereas no statistical differences in interleukin-6 levels were found between the two groups. After operation, pulmonary gas exchange function (arterial oxygen tension at a fraction of inspired oxygen of 0.4) was significantly higher in the leukocyte-depletion group 1 hour after arrival to the intensive care unit (p < 0.05) and after extubation (p < 0.05). There were no statistical differences between the two groups with respect to postoperative circulating platelet levels and blood loss, and no infections were observed during the whole period of hospitalization. These results suggest that leukocyte depletion of the residual heart-lung machine blood improves postoperative lung gas exchange function and is safe for patients who are expected to have a severe inflammatory response after heart operations.
动物实验已证明，体外循环期间进行白细胞去除可改善肺功能。然而，关于在体外循环开始时通过动脉滤器进行临床白细胞去除，却有相互矛盾的报道。在本研究中，我们探讨了在体外循环结束时从心肺机剩余血液中去除白细胞是否会改善肺功能并减轻术后炎症反应。30例行择期心脏手术的患者被随机分为白细胞去除组和对照组。在白细胞去除组（n = 20）中，所有剩余血液（1.2至2.1升）通过白细胞去除滤器过滤，并在体外循环后回输，而在对照组中，相同量的体外循环后剩余血液未经过滤直接回输（n = 10）。与对照组相比，白细胞去除使回输血中的白细胞减少了97%以上（p < 0.01），并显著降低了循环白细胞（p < 0.05）和粒细胞（p < 0.05）。手术结束时测定的炎症介质血栓素B2水平在去除组显著低于对照组（p < 0.05），而两组间白细胞介素-6水平无统计学差异。术后，白细胞去除组在进入重症监护病房1小时后（p < 0.05）和拔管后（p < 0.05）的肺气体交换功能（吸入氧分数为0.4时的动脉血氧张力）显著高于对照组。两组在术后循环血小板水平和失血量方面无统计学差异，且在整个住院期间未观察到感染。这些结果表明，去除心肺机剩余血液中的白细胞可改善术后肺气体交换功能，对预计心脏手术后会出现严重炎症反应的患者是安全的。
