Martin W, Carter R, Tweddel A, Belch J, el-Fiky M, McQuiston A M, McLaren M, Wheatley D J
Department of Cardiac Surgery, Glasgow Royal Infirmary, University NHS Trust, Scotland.
Eur J Cardiothorac Surg. 1996;10(9):774-83. doi: 10.1016/s1010-7940(96)80339-3.
Cardiopulmonary bypass induces respiratory dysfunction postoperatively, with activation of both the complement system and white cells implicated. This study compared the effects of bubble and membrane oxygenators for cardiopulmonary bypass in terms of respiratory dysfunction and markers of white cell activation and endothelial damage.
Fifty patients undergoing cardiopulmonary bypass were randomly allocated either membrane or bubble oxygenation. Respiratory function was assessed serially by arterial oxygen tension and alveolar-arterial oxygen gradient. Complement activation was measured by serial sampling of serum C3a levels. White cell activation was assessed by serial measurement granulocyte elastase; other markers investigated were levels of thromboxane B2, von Willebrand factor and malondialdehyde. All sample measurements were made preoperatively, early and late during bypass, 4-6 h postoperatively and then on the 1st, 2nd and 6th postoperative day. All samples were corrected for haemodilution, and differences between groups tested non-parametrically.
In both groups of patients there was a highly significant fall (P < 0.001) in arterial oxygen tension accompanied by a highly significant rise (P < 0.0001) in aleveolar-arterial oxygen gradient at 18 h compared to preoperative values persisting until 6 days postoperatively. Levels of C3a increased significantly in both groups at 10 min post bypass, increased further at 60 min peaking at 4-6 h post bypass. Granulocyte elastase serum levels increased significantly at 10 min postoperatively in both groups compared to control levels, remaining elevated till 48 h, but returning to control levels by 6 days. There was a small difference (P < 0.04) between the groups at 4-6 h only. Levels of von Willebrand factor increased significantly at 60 min post bypass in both groups, remaining elevated 6 days postoperatively. Levels of malondialdehyde increased at 10 min post bypass, remaining elevated until 6 days post bypass. Thromboxane levels showed no significant changes. For all markers measured, there were no significant differences between the groups other than those already indicated.
This study demonstrated marked respiratory dysfunction, complement activation and white cell activation in patients undergoing cardiopulmonary bypass with either bubble or membrane oxygenators. There was marked variability in the response of individual patients with either oxygenation technique, but overall no significant differences between the groups.
体外循环术后会引发呼吸功能障碍，这与补体系统和白细胞的激活有关。本研究比较了鼓泡式氧合器和膜式氧合器在体外循环时对呼吸功能障碍以及白细胞激活和内皮损伤标志物的影响。
50例接受体外循环的患者被随机分配使用膜式或鼓泡式氧合。通过动脉血氧分压和肺泡 - 动脉血氧梯度连续评估呼吸功能。通过连续采集血清C3a水平来测量补体激活情况。通过连续测量粒细胞弹性蛋白酶来评估白细胞激活；研究的其他标志物包括血栓素B2、血管性血友病因子和丙二醛水平。所有样本测量均在术前、体外循环期间早期和晚期、术后4 - 6小时以及术后第1天、第2天和第6天进行。所有样本均针对血液稀释进行校正，组间差异采用非参数检验。
与术前值相比，两组患者在18小时时动脉血氧分压均显著下降（P < 0.001），同时肺泡 - 动脉血氧梯度显著升高（P < 0.0001），且这种情况一直持续到术后6天。两组患者在体外循环后10分钟时C3a水平均显著升高，在60分钟时进一步升高，并在体外循环后4 - 6小时达到峰值。与对照水平相比，两组患者术后10分钟时粒细胞弹性蛋白酶血清水平均显著升高，一直升高到48小时，但在6天时恢复到对照水平。仅在4 - 6小时时两组之间存在微小差异（P < 0.04）。两组患者在体外循环后60分钟时血管性血友病因子水平均显著升高，术后6天仍保持升高。丙二醛水平在体外循环后10分钟时升高，一直升高到体外循环后6天。血栓素水平无显著变化。对于所有测量的标志物，除已指出的差异外，两组之间无显著差异。
本研究表明，使用鼓泡式或膜式氧合器进行体外循环的患者均出现明显的呼吸功能障碍、补体激活和白细胞激活。两种氧合技术下个体患者的反应存在明显差异，但总体而言两组之间无显著差异。
