Journois D, Israel-Biet D, Pouard P, Rolland B, Silvester W, Vouhé P, Safran D
Department of Anesthesia and Intensive Care Medicine, Hôpital Laennec, Paris, France.
Anesthesiology. 1996 Nov;85(5):965-76. doi: 10.1097/00000542-199611000-00003.
In previous studies, researchers suggested a beneficial role of hemofiltration performed during cardiopulmonary bypass in children. This study was performed to assess both clinical effects and inflammatory mediator removal by high-volume, zero-fluid balance ultrafiltration during rewarming (Z-BUF).
Twenty children undergoing cardiac surgery were assigned randomly to Z-BUF or a control group. Plasma C3a, interleukin (IL)-1, IL-6, IL-8, IL-10, tumor necrosis factor, myeloperoxidase, and leukocyte count were measured before (T1) and after (T2) hemofiltration and 24 h later (T3). The intensive care unit staff was blinded to the patient's group. Postoperative alveolar-arterial oxygen gradient, time to extubation, body temperature, and postoperative blood loss were monitored.
Ultrafiltration rate was 4,972 (3,183-6,218) mL/m2 (median [minimum-maximum]) in the Z-BUF group, where significant reductions were observed in postoperative blood loss, time to extubation (10.8[9-18] vs. 28.2 [15-58] h) and postoperative alveolar-arterial oxygen gradient (320 [180-418] vs. 551 [485-611] mmHg at T3). In the Z-BUF group, significant removal of tumor necrosis factor, IL-10, myeloperoxidase, and C3a were observed at T2. Interleukin 1, IL-6, IL-8, and myeloperoxidase were decreased at T3, suggesting earlier removal of factor(s) that may trigger their release.
These results suggest that hemofiltration exerts some beneficial clinical effects that are not due to water removal. The role of the early removal of factors triggering the inflammatory response, rather than a direct removal of cytokines, deserves further investigation.
在先前的研究中，研究人员提出了在儿童体外循环期间进行血液滤过的有益作用。本研究旨在评估复温期间高容量、零液体平衡超滤（Z-BUF）的临床效果和炎症介质清除情况。
20名接受心脏手术的儿童被随机分配至Z-BUF组或对照组。在血液滤过前（T1）、后（T2）及24小时后（T3）测量血浆C3a、白细胞介素（IL）-1、IL-6、IL-8、IL-10、肿瘤坏死因子、髓过氧化物酶和白细胞计数。重症监护病房的工作人员对患者分组情况不知情。监测术后肺泡动脉氧梯度、拔管时间、体温和术后失血量。
Z-BUF组的超滤率为4,972（3,183 - 6,218）mL/m2（中位数[最小值 - 最大值]），该组术后失血量、拔管时间（10.8[9 - 18]小时对28.2[15 - 58]小时）和术后肺泡动脉氧梯度（T3时320[180 - 418]mmHg对551[485 - 611]mmHg）均显著降低。在Z-BUF组中，T2时观察到肿瘤坏死因子、IL-10、髓过氧化物酶和C3a显著清除。T3时白细胞介素1、IL-6、IL-8和髓过氧化物酶降低，提示可能触发其释放的因子被更早清除。
这些结果表明血液滤过发挥了一些并非因脱水所致的有益临床效果。早期清除触发炎症反应的因子而非直接清除细胞因子的作用值得进一步研究。
