Barry M C, Kelly C, Burke P, Sheehan S, Redmond H P, Bouchier-Hayes D
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Br J Surg. 1997 Apr;84(4):513-9.
The aims of this study were to evaluate the effects of aortic clamping and unclamping on neutrophil and monocyte activation and release of plasma mediators in 20 patients undergoing elective aortic aneurysm surgery, and to correlate these findings with pulmonary haemodynamics and gas exchange.
Simultaneous arterial and mixed venous samples were obtained during and after aortic clamping and unclamping.
Neutrophil respiratory burst activity in mixed venous samples increased significantly during the period of aortic clamping. An initial increase in neutrophil CD11b expression in venous blood 5 min after clamp removal was followed by a significant decrease in level of expression. Plasma tumour necrosis factor levels increased at the end of the cross-clamp period and reached a maximum 60 min following reperfusion. There was a significant and sustained rise in plasma thromboxane B2 levels following clamp removal. This increase correlated with the development of increased pulmonary vascular resistance.
This study confirms the central role played by activated neutrophils in the early stages of reperfusion injury and also suggests a role for plasma mediators in mediating cardiopulmonary dysfunction during major vascular surgery.
本研究旨在评估20例行择期主动脉瘤手术患者在主动脉阻断和开放期间中性粒细胞和单核细胞的激活情况以及血浆介质的释放，并将这些结果与肺血流动力学和气体交换进行关联。
在主动脉阻断期间及之后同时采集动脉血和混合静脉血样本。
在主动脉阻断期间，混合静脉血样本中的中性粒细胞呼吸爆发活性显著增加。在松开阻断钳5分钟后，静脉血中中性粒细胞CD11b表达最初增加，随后表达水平显著下降。在阻断期结束时血浆肿瘤坏死因子水平升高，并在再灌注后60分钟达到峰值。松开阻断钳后血浆血栓素B2水平显著且持续升高。这种升高与肺血管阻力增加的发生相关。
本研究证实了激活的中性粒细胞在再灌注损伤早期所起的核心作用，同时也表明血浆介质在介导大血管手术期间心肺功能障碍中发挥作用。
